Collier Drug Stores Inc
Organization Active NPI Long Term Care Pharmacy · Fayetteville, AR
NPI 1801425624 · NPPES record last updated Feb 20, 2024
Key facts
- NPI
- 1801425624
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Long Term Care Pharmacy 3336L0003X
- Legal business name
- COLLIER DRUG STORES INC
- Practice address
- 102 W Dickson St Ste 5
Fayetteville, AR 72701-5243 - Phone
- (479) 935-4345
- NPI assigned
- Apr 3, 2020
- Organization subpart
- No
Authorized official
- Name
- Mel Collier
- Title
- Owner
- Phone
- (479) 442-6262
Other NPIs on the same Medicare enrollment 9
Corporate family (same tax ID) 18
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
Locations
102 W Dickson St
Ste 5
Fayetteville, AR 72701
Phone (479) 442-7344
100 W Dickson St
Fayetteville, AR 72701
Phone (479) 442-6262
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | |||
| Compounding Pharmacy | 3336C0004X | |||
| Long Term Care Pharmacy | 3336L0003X | Yes |
Addresses
Primary practice location
102 W Dickson St Ste 5
Fayetteville, AR 72701-5243
Mailing address
PO Box 1085
Fayetteville, AR 72702-1085
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992736 | Other | PK | |
| 100232407 | Medicaid | AR |
Other names
- Collier Pharmacy Services
Other providers in Fayetteville, AR
- Andrew Coles
- Sara Joy Collie
- Collier Drug Stores Inc
- Collier Drug Stores Inc
- Collier Drug Stores Inc
- Carl Melvin Collier
- Camron Collins
- Laura Rose Collins
- Nicole D Collins
- Colon & Rectal Surgical Associates
All providers in Fayetteville, AR · Long Term Care Pharmacy in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.