Healthcare Provider Details

I. General information

NPI: 1609352566
Provider Name (Legal Business Name): TRIPHARMA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 01/05/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 SW REGIONAL AIRPORT BLVD STE 2
BENTONVILLE AR
72712
US

IV. Provider business mailing address

PO BOX 1095
GRAVETTE AR
72736-1095
US

V. Phone/Fax

Practice location:
  • Phone: 479-271-9355
  • Fax: 479-770-0113
Mailing address:
  • Phone: 479-271-9355
  • Fax: 479-271-9357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN LYKINS
Title or Position: OWNER
Credential:
Phone: 479-770-0111