NPIMap

Organization Active NPI

Collier Drug Stores, Inc.

Doing business as Collier Drug-Centerton

  • Community/Retail Pharmacy
  • Centerton, AR
National Provider Identifier
1275528069
Registry record updated Feb 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
COLLIER DRUG STORES, INC.
Doing business as
Collier Drug-Centerton
Practice address
991 W Centerton Blvd
Centerton, AR 72719-8707
Phone
(479) 795-8199
Fax
(479) 795-8196
NPI assigned
Sep 17, 2005
Last updated
Feb 20, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2024

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

Authorized official

Name
Carl Melvin CollierNPI 1871609925
Title
Owner
Phone
(479) 442-6262

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
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

991 W Centerton Blvd
Centerton, AR 72719-8707

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
148779407MedicaidAR

Other names 1

  • Collier Drug-Centerton Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

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…

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory
Tax ID family
Collier Drug Stores Inc19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

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

View all 18

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": "1126915200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708387200000",
    "number": "1275528069",
    "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": "72702",
            "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": "991 W CENTERTON BLVD",
            "city": "CENTERTON",
            "state": "AR",
            "postal_code": "727198707",
            "telephone_number": "479-795-8199",
            "fax_number": "479-795-8196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLIER DRUG STORES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-17",
        "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"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "148779407",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Collier Drug-Centerton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Centerton, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.