NPIMap

Organization Active NPI

Caldwell Discount Drug Co., Inc.

  • Pharmacy
  • Wynne, AR
National Provider Identifier
1992703243
Registry record updated Jun 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
AR-14982 Issued in AR
Legal business name
CALDWELL DISCOUNT DRUG CO., INC.
Practice address
804 Falls Blvd S
Wynne, AR 72396-3505
Phone
(870) 238-7085
Fax
(870) 238-8937
NPI assigned
Jul 11, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2021

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

Authorized official

Name
Max Allen Caldwell, RPH
Title
Pharmacist/Owner
Phone
(870) 238-7085

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X AR-14982 AR Primary
Long Term Care Pharmacy 3336L0003X

Addresses

Primary practice location

804 Falls Blvd S
Wynne, AR 72396-3505

Mailing address

PO Box 1084
804 South Falls Blvd
Wynne, AR 72396-1084
Phone (870) 238-7085

Other identifiers 1

IdentifierTypeStateIssuer
113383407MedicaidAR

Other names 1

  • Caldwell Discount Drug Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20100930078921 AR DME Supplier - PharmacyDME Supplier - Medical Supply Company With Registered PharmacistDME Supplier - Pedorthic Personnel 7911018882 Practice locations: Wynne, AR
O20111101000120 AR Part B Supplier - Mass Immunization (Roster Biller Only) 7911018882 Practice locations: Wynne, AR
O20151013000254 AR Part B Supplier - Pharmacy 7911018882 Practice locations: Wynne, AR

National Provider Directory

National Provider Directory
Tax ID family
Caldwell Discount Drug4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1121040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623196800000",
    "number": "1992703243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1084",
            "address_2": "804 SOUTH FALLS BLVD",
            "city": "WYNNE",
            "state": "AR",
            "postal_code": "723961084",
            "telephone_number": "870-238-7085",
            "fax_number": "870-238-8937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 FALLS BLVD S",
            "city": "WYNNE",
            "state": "AR",
            "postal_code": "723963505",
            "telephone_number": "870-238-7085",
            "fax_number": "870-238-8937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CALDWELL DISCOUNT DRUG CO., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-11",
        "last_updated": "2021-06-09",
        "certification_date": "2021-06-09",
        "status": "A",
        "authorized_official_last_name": "CALDWELL",
        "authorized_official_first_name": "MAX",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "PHARMACIST/OWNER",
        "authorized_official_telephone_number": "870-238-7085",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "AR",
            "license": "AR-14982",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113383407",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Caldwell Discount Drug",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Caldwell Discount Drug",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wynne, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2021; 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.