Tommys Rexall Drug Company Inc.
Organization Active NPI Pharmacist · Dewitt, AR
NPI 1962553404 · NPPES record last updated Sep 1, 2017
Key facts
- NPI
- 1962553404
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacist 183500000X
- License
- AR14071 (AR)
- Legal business name
- TOMMYS REXALL DRUG COMPANY INC.
- Practice address
- 220 Court SQ
Dewitt, AR 72042-2057 - Phone
- (870) 946-4221
- Fax
- (870) 946-1181
- NPI assigned
- Jan 12, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Tommy Glenn Black, P.D.
- Title
- Pharmacist
- Phone
- (870) 946-4221
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 1
Practitioners 3
-
Vernon Dewayne Crowell Jr., PHARMD
-
James Mackenzie Daugherty, PHARM.D
-
Kristi Leigh Whitmore, PHARM.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160726003102 | AR | Part B Supplier - Mass Immunization (Roster Biller Only) | 7416076344 |
1 other NPI on this enrollment Practice locations: De Witt, AR |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist |
183500000X | AR14071 | AR | Yes |
| Community/Retail Pharmacy | 3336C0003X | |||
| Long Term Care Pharmacy | 3336L0003X |
Addresses
Primary practice location
220 Court SQ
Dewitt, AR 72042-2057
Mailing address
220 Court SQ
Dewitt, AR 72042-2057
Phone (870) 946-4221
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100643407 | Medicaid | AR | |
| 120942716 | Medicaid | AR |
Other providers in Dewitt, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 1, 2017. 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.