Eudora Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

AR19689 Issued in AR

Legal business name

EUDORA PHARMACY INC

Practice address

200 S Main St
Eudora, AR 71640-3061

Phone

(870) 355-4448

Fax

(870) 355-2444

NPI assigned

Jul 30, 2006

Organization subpart

No

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

Authorized official

Name

Khalil Crouse, RPH

Title

Owner

Phone

(870) 355-4448

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• EUDORA DRUG STORE Doing business as

Medicare fee-for-service enrollment

Enrolled in AR2 enrollments

Enrollment records 2

Tax ID family

Eudora Drug Store2 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.

• Eudora Pharmacy Inc

  • Long Term Care Pharmacy
  • Eudora, AR
  • NPI 1982388294
  NPD tax ID

Locations

Practitioners 2

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

• Andrew Joseph Cefalu, PHARMACIST

  • Pharmacist
  • Eudora, AR
  • NPI 1730166133
  NPD (past)
• Ashley Young Rutledge, PHARM D

  • Pharmacist
  • Eudora, AR
  • NPI 1932705589
  NPD (past)

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647302400000",
    "number": "1275548828",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 S MAIN ST",
            "city": "EUDORA",
            "state": "AR",
            "postal_code": "716403061",
            "telephone_number": "870-355-4448",
            "fax_number": "870-355-2444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EUDORA PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2022-03-15",
        "certification_date": "2022-03-15",
        "status": "A",
        "authorized_official_last_name": "CROUSE",
        "authorized_official_first_name": "KHALIL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "870-355-4448",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AR",
            "license": "AR19689",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "1992912",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "160503407",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EUDORA DRUG STORE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "EUDORA DRUG STORE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• CBK Mother Goose
• Andrew Joseph Cefalu, PHARMACIST
• Peter Chu, O.D
• Elite Medical Services, Inc.
• Shirley Ellis, SLPD, CCC-SLP
• Eudora Pharmacy Inc
• Cassidy Jo L Gavin Sanders, APRN
• Genesis Medical Center
• Ruby J. Lee, D.D.S.
• Mainline Health Systems, Inc

• All providers in Eudora, AR
• Community/Retail Pharmacy in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2022; 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.