NPIMap

Organization Active NPI

Collier Drug Stores Inc

  • Long Term Care Pharmacy
  • Prairie Grove, AR
National Provider Identifier
1619660198
Registry record updated Feb 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
COLLIER DRUG STORES INC
Practice address
801 E Douglas St
Prairie Grove, AR 72753-2737
Phone
(479) 246-2195
Fax
(479) 846-2147
NPI assigned
May 31, 2023
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 Collier Jr.
Title
Owner
Phone
(479) 442-6262

Specialties & licenses 1

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

Addresses

Primary practice location

801 E Douglas St
Prairie Grove, AR 72753-2737

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
145056407MedicaidAR

Other names 1

  • Collier Drug - Prairie Grove Doing business as

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

NPI Registry JSON

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

{
    "created_epoch": "1685491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708387200000",
    "number": "1619660198",
    "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": "801 E DOUGLAS ST",
            "city": "PRAIRIE GROVE",
            "state": "AR",
            "postal_code": "727532737",
            "telephone_number": "479-246-2195",
            "fax_number": "479-846-2147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLIER DRUG STORES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-31",
        "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": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "145056407",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Collier Drug - Prairie Grove",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Collier Drug - Prairie Grove",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Prairie Grove, 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.