Provider Demographics
NPI:1487635884
Name:ROSE DRUG OF DOVER INC
Entity type:Organization
Organization Name:ROSE DRUG OF DOVER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARMON
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:479-331-2133
Mailing Address - Street 1:PO BOX 335
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:AR
Mailing Address - Zip Code:72837-0335
Mailing Address - Country:US
Mailing Address - Phone:479-331-2133
Mailing Address - Fax:479-331-4003
Practice Address - Street 1:8880 MARKET ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:AR
Practice Address - Zip Code:72837-9111
Practice Address - Country:US
Practice Address - Phone:479-331-2133
Practice Address - Fax:479-331-4003
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROSE DRUG OF DOVER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-11
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR130165407Medicaid
4491640002Medicare NSC