Healthcare Provider Details

I. General information

NPI: 1225759640
Provider Name (Legal Business Name): DLSN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2022
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 FRONT ST
CONWAY AR
72032-4304
US

IV. Provider business mailing address

924 FRONT ST
CONWAY AR
72032-4304
US

V. Phone/Fax

Practice location:
  • Phone: 501-329-5626
  • Fax: 501-329-1977
Mailing address:
  • Phone: 501-329-5626
  • Fax: 501-329-1977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JAMES ANDREW DALLAS
Title or Position: MANAGING MEMBER
Credential: PHARMD
Phone: 501-329-5626