1336208602 NPI number — BRUCE DRUGS INC

Table of content: (NPI 1336208602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336208602 NPI number — BRUCE DRUGS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRUCE DRUGS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
EDGAR FLOYD HENLEY PROPERTYS BRUCE DRUGS INC
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336208602
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
711 BROADWAY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SMACKOVER
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71762-1822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-725-2401
Provider Business Mailing Address Fax Number:
870-725-2853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
711 BROADWAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMACKOVER
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71762-1822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-725-2401
Provider Business Practice Location Address Fax Number:
870-725-2853
Provider Enumeration Date:
12/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HENLEY
Authorized Official First Name:
ED.
Authorized Official Middle Name:
F
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
870-863-9867

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  0406101 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0406101 . This is a "PHARMACY ID" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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