Healthcare Provider Details

I. General information

NPI: 1477694594
Provider Name (Legal Business Name): PSI ARKANSAS ACQUISITION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 02/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 COLLEGE AVE SUITE 2
CONWAY AR
72034-6210
US

IV. Provider business mailing address

201 E 4TH ST 900 OMNICARE CENTER
CINCINNATI OH
45202-4248
US

V. Phone/Fax

Practice location:
  • Phone: 501-764-1414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ANGELA JAMES
Title or Position: REGULATORY LICENSING MANGAGER
Credential:
Phone: 513-719-2600