Provider Demographics
NPI:1053605287
Name:C B F M C INC
Entity type:Organization
Organization Name:C B F M C INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:C.F.O.
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMPLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-932-0150
Mailing Address - Street 1:202 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-3102
Mailing Address - Country:US
Mailing Address - Phone:870-932-0150
Mailing Address - Fax:870-932-0870
Practice Address - Street 1:202 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3102
Practice Address - Country:US
Practice Address - Phone:870-932-0150
Practice Address - Fax:870-932-0870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
ARAR203703336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2133732OtherPK
0423854OtherNCPDP PROVIDER IDENTIFICATION NUMBER