Provider Demographics
NPI:1720268378
Name:MCGEHEE DRUG COMPANY LLC
Entity type:Organization
Organization Name:MCGEHEE DRUG COMPANY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:T
Authorized Official - Last Name:HOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:870-222-6676
Mailing Address - Street 1:1007 HIGHWAY 65 S
Mailing Address - Street 2:
Mailing Address - City:MC GEHEE
Mailing Address - State:AR
Mailing Address - Zip Code:71654-9417
Mailing Address - Country:US
Mailing Address - Phone:870-222-6676
Mailing Address - Fax:870-222-6679
Practice Address - Street 1:1007 HIGHWAY 65 S
Practice Address - Street 2:
Practice Address - City:MC GEHEE
Practice Address - State:AR
Practice Address - Zip Code:71654-9417
Practice Address - Country:US
Practice Address - Phone:870-222-6676
Practice Address - Fax:870-222-6679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
ARAR176353336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1995263OtherPK
AR223559407Medicaid
1995263OtherPK