NPIMap

Collier Drug Stores Inc

Organization Active NPI Community/Retail Pharmacy · Springdale, AR

NPI 1073921177 · NPPES record last updated Feb 20, 2024

Key facts

NPI
1073921177
Entity type
Organization (NPI type 2)
Primary specialty
Community/Retail Pharmacy 3336C0003X
License
AR20756 (AR)
Legal business name
COLLIER DRUG STORES INC
Practice address
171 N Maestri Rd Ste 3
Springdale, AR 72762-9818
Phone
(479) 361-5727
Fax
(479) 361-5623
NPI assigned
Aug 1, 2014
Organization subpart
No

Authorized official

Name
Carl Melvin Collier Jr.
Title
Owner
Phone
(479) 442-6262

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Corporate family (same tax ID) 18

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled in AR

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20110207000110 AR Part B Supplier - Mass Immunization (Roster Biller Only) 5294889358 12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tontitown, AR; Prairie Grove, AR; Lowell, AR; Johnson, AR; Fayetteville, AR; Farmington, AR; Elkins, AR; Centerton, AR…

National Provider Directory

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

Locations

171 N Maestri Rd
#3
Tontitown, AR 72762
Phone (479) 361-5727

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X AR20756 AR Yes
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

171 N Maestri Rd Ste 3
Springdale, AR 72762-9818

Mailing address

PO Box 1085
Fayetteville, AR 72702-1085
Phone (479) 935-4303

Other identifiers

IdentifierTypeStateIssuer
2146602OtherPK

Other names

  • Collier Drug-Har-Ber 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": "1406851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708387200000",
    "number": "1073921177",
    "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": "479-935-4303",
            "fax_number": "479-521-9111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "171 N MAESTRI RD STE 3",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727629818",
            "telephone_number": "479-361-5727",
            "fax_number": "479-361-5623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLIER DRUG STORES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-01",
        "last_updated": "2024-02-20",
        "certification_date": "2024-02-20",
        "status": "A",
        "authorized_official_last_name": "COLLIER",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "MELVIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-442-6262",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AR",
            "license": "AR20756",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2146602",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Collier Drug-Har-Ber",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Collier Drug-Har-Ber",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Springdale, AR

All providers in Springdale, AR · Community/Retail Pharmacy in Arkansas

Sources for this page

Verify at the official NPI Registry.