Healthcare Provider Details

I. General information

NPI: 1124658141
Provider Name (Legal Business Name): TRIPHARMA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2020
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3380 N WIMBERLY DR., STE 3
FAYETTEVILLE AR
72703
US

IV. Provider business mailing address

PO BOX 1095
GRAVETTE AR
72736-1095
US

V. Phone/Fax

Practice location:
  • Phone: 479-527-9355
  • Fax: 479-527-6454
Mailing address:
  • Phone: 479-271-9355
  • Fax: 479-271-9357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JAMES GARLAND
Title or Position: MANAGER
Credential:
Phone: 479-271-9355