Healthcare Provider Details

I. General information

NPI: 1861438772
Provider Name (Legal Business Name): SOUTH ARKANSAS OIL CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 N WEST AVE
EL DORADO AR
71730-3124
US

IV. Provider business mailing address

PO BOX 9830
SALT LAKE CITY UT
84109-9830
US

V. Phone/Fax

Practice location:
  • Phone: 870-864-0730
  • Fax: 870-864-0522
Mailing address:
  • Phone: 870-864-0730
  • Fax: 870-864-0522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License NumberAR20347
License Number StateAR

VIII. Authorized Official

Name: ALAN HARPER
Title or Position: PIC
Credential: RPH
Phone: 870-864-0730