Provider Demographics
NPI:1861673915
Name:CANADA, INC.
Entity type:Organization
Organization Name:CANADA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER-PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:CANADA
Authorized Official - Suffix:JR
Authorized Official - Credentials:REGISTERED PHARMACIS
Authorized Official - Phone:870-382-4343
Mailing Address - Street 1:PO BOX 185
Mailing Address - Street 2:101 W. WATERMAN STREET
Mailing Address - City:DUMAS
Mailing Address - State:AR
Mailing Address - Zip Code:71639-0185
Mailing Address - Country:US
Mailing Address - Phone:870-382-4343
Mailing Address - Fax:870-382-5692
Practice Address - Street 1:101 W. WATERMAN ST
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:AR
Practice Address - Zip Code:71639-0185
Practice Address - Country:US
Practice Address - Phone:870-382-4343
Practice Address - Fax:870-382-4343
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CANADA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-16
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR127037407Medicaid
AR127037407Medicaid