Provider Demographics
NPI:1487250015
Name:GURDON PHARMACY LLC
Entity type:Organization
Organization Name:GURDON PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-642-2620
Mailing Address - Street 1:104 S. 6TH ST
Mailing Address - Street 2:
Mailing Address - City:GURDON
Mailing Address - State:AR
Mailing Address - Zip Code:71743
Mailing Address - Country:US
Mailing Address - Phone:870-353-9900
Mailing Address - Fax:844-805-7807
Practice Address - Street 1:104 S. 6TH ST
Practice Address - Street 2:
Practice Address - City:GURDON
Practice Address - State:AR
Practice Address - Zip Code:71743
Practice Address - Country:US
Practice Address - Phone:870-353-9900
Practice Address - Fax:844-805-7807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-09
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR262898407Medicaid