Provider Demographics
NPI:1124048699
Name:ECONOMY DRUG OF DEWITT
Entity type:Organization
Organization Name:ECONOMY DRUG OF DEWITT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIEF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ALTON
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBLESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-946-1706
Mailing Address - Street 1:PO BOX 588
Mailing Address - Street 2:
Mailing Address - City:DE WITT
Mailing Address - State:AR
Mailing Address - Zip Code:72042-0588
Mailing Address - Country:US
Mailing Address - Phone:870-946-1048
Mailing Address - Fax:
Practice Address - Street 1:1626 S MADISON ST
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:AR
Practice Address - Zip Code:72042-3003
Practice Address - Country:US
Practice Address - Phone:870-946-1706
Practice Address - Fax:870-946-3024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR15972183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR128818407Medicaid
ARAR15972OtherPHARMACY
ARAR15972OtherPHARMACY
ARAR15972OtherPHARMACY