NPIMap

Organization Active NPI

Collier Drug Stores Inc

Doing business as Collier Pharmacy Services

  • Long Term Care Pharmacy
  • Fayetteville, AR
National Provider Identifier
1801425624
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
Doing business as
Collier Pharmacy Services
Practice address
102 W Dickson St Ste 5
Fayetteville, AR 72701-5243
Phone
(479) 935-4345
NPI assigned
Apr 3, 2020
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
Mel Collier
Title
Owner
Phone
(479) 442-6262

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X
Compounding Pharmacy 3336C0004X
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

102 W Dickson St Ste 5
Fayetteville, AR 72701-5243

Mailing address

PO Box 1085
Fayetteville, AR 72702-1085

Other names 1

  • Collier Pharmacy Services 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

Locations

100 W Dickson St
Fayetteville, AR 72701
Phone (479) 442-6262

NPI Registry JSON

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

{
    "created_epoch": "1585872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708387200000",
    "number": "1801425624",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 W DICKSON ST STE 5",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727015243",
            "telephone_number": "479-935-4345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLIER DRUG STORES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-03",
        "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": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Collier Pharmacy Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fayetteville, 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.