NPIMap

Organization Active NPI

Monticello Drug Company LLC

Doing business as City Drug

  • Long Term Care Pharmacy
  • Monticello, AR
National Provider Identifier
1063286607
Registry record updated Nov 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
MONTICELLO DRUG COMPANY LLC
Doing business as
City Drug
Practice address
201 E Gaines St
Monticello, AR 71655-4903
Phone
(870) 367-5301
Fax
(870) 460-0257
NPI assigned
Nov 14, 2023
Last updated
Nov 14, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Khalil CrouseNPI 1962454868
Title
Owner
Phone
(870) 265-2220

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

201 E Gaines St
Monticello, AR 71655-4903

Mailing address

PO Box 552
Lake Village, AR 71653-0552
Phone (870) 265-2220

Other names 1

  • City Drug Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Monticello Drug Company LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1699920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699920000000",
    "number": "1063286607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 552",
            "city": "LAKE VILLAGE",
            "state": "AR",
            "postal_code": "716530552",
            "telephone_number": "870-265-2220",
            "fax_number": "870-265-2226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 E GAINES ST",
            "city": "MONTICELLO",
            "state": "AR",
            "postal_code": "716554903",
            "telephone_number": "870-367-5301",
            "fax_number": "870-460-0257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTICELLO DRUG COMPANY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-14",
        "last_updated": "2023-11-14",
        "certification_date": "2023-11-14",
        "status": "A",
        "authorized_official_last_name": "CROUSE",
        "authorized_official_first_name": "KHALIL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "870-265-2220"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "City Drug",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Monticello, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.