Provider Demographics
NPI:1528821659
Name:BIG WORLD DRUG ENTERPRISES INC
Entity type:Organization
Organization Name:BIG WORLD DRUG ENTERPRISES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ORVILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GEDDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-675-3900
Mailing Address - Street 1:1531 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72927-4921
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1531 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72927-4921
Practice Address - Country:US
Practice Address - Phone:479-675-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR161200407Medicaid