Healthcare Provider Details

I. General information

NPI: 1790027449
Provider Name (Legal Business Name): J J J SMITH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 DAVE WARD DR ST 602
CONWAY AR
72034
US

IV. Provider business mailing address

2425 DAVE WARD DRIVE ST 602
CONWAY AR
72034
US

V. Phone/Fax

Practice location:
  • Phone: 501-336-8188
  • Fax: 501-336-8177
Mailing address:
  • Phone: 501-336-8188
  • Fax: 501-336-8177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberAR20709
License Number StateAR

VIII. Authorized Official

Name: ROBERT BLAKE JOHNSON
Title or Position: OWNER / PHARMACIST
Credential: PHARM. D.
Phone: 501-336-8188