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Collier Drug Stores Inc

Organization Active NPI Compounding Pharmacy · Springdale, AR

NPI 1063775666 · NPPES record last updated Feb 20, 2024

Key facts

NPI
1063775666
Entity type
Organization (NPI type 2)
Primary specialty
Compounding Pharmacy 3336C0004X
License
AR20673 (AR)
Legal business name
COLLIER DRUG STORES INC
Practice address
5203 Willow Creek Dr Ste 1
Springdale, AR 72762-0876
Phone
(479) 935-4336
NPI assigned
Jun 19, 2012
Organization subpart
No

Authorized official

Name
Mel Collier
Title
Owner
Phone
(479) 442-6262

Corporate family (same tax ID) 18

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

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

Tax ID family
Collier Drug Stores Inc (19 organizations share this tax ID)

Locations

5203 Willow Creek Dr
Ste 1
Springdale, AR 72762
Phone (479) 935-4336

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Compounding Pharmacy 3336C0004X AR20673 AR Yes

Addresses

Primary practice location

5203 Willow Creek Dr Ste 1
Springdale, AR 72762-0876

Mailing address

PO Box 1085
Fayetteville, AR 72702-1085
Phone (479) 442-6262

Other identifiers

IdentifierTypeStateIssuer
2135550OtherPK

Other names

  • Collier Compounding Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 20, 2024.

{
    "created_epoch": "1340064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708387200000",
    "number": "1063775666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1085",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727021085",
            "telephone_number": "479-442-6262",
            "fax_number": "479-521-9111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5203 WILLOW CREEK DR STE 1",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727620876",
            "telephone_number": "479-935-4336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLIER DRUG STORES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-19",
        "last_updated": "2024-02-20",
        "certification_date": "2024-02-20",
        "status": "A",
        "authorized_official_last_name": "COLLIER",
        "authorized_official_first_name": "MEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-442-6262"
    },
    "taxonomies": [
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "AR",
            "license": "AR20673",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2135550",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Collier Compounding",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Collier Compounding",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Springdale, AR

All providers in Springdale, AR · Compounding Pharmacy in Arkansas

Sources for this page

Verify at the official NPI Registry.