Provider Demographics
NPI:1063427516
Name:ORRELL ENTERPRISES INCORPORATED
Entity type:Organization
Organization Name:ORRELL ENTERPRISES INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:ORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:871-423-6677
Mailing Address - Street 1:209 CARTER ST
Mailing Address - Street 2:
Mailing Address - City:BERRYVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72616-4303
Mailing Address - Country:US
Mailing Address - Phone:870-423-6677
Mailing Address - Fax:870-423-5725
Practice Address - Street 1:209 CARTER ST
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:AR
Practice Address - Zip Code:72616-4303
Practice Address - Country:US
Practice Address - Phone:870-423-6677
Practice Address - Fax:870-423-5725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR119483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0411948OtherNCPDP PROVIDER IDENTIFICATION NUMBER
AR118843716Medicaid
AR100748407Medicaid
MO606903508Medicaid
0411948OtherNCPDP PROVIDER IDENTIFICATION NUMBER