Healthcare Provider Details

I. General information

NPI: 1255930509
Provider Name (Legal Business Name): SIRIUS B APOTHECARY & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 10/19/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 VISTA AVE
HOT SPRINGS AR
71901-7019
US

IV. Provider business mailing address

203 VISTA AVE
HOT SPRINGS AR
71901-7019
US

V. Phone/Fax

Practice location:
  • Phone: 501-487-1903
  • Fax:
Mailing address:
  • Phone: 501-497-1903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: CHARDONNE DIXON
Title or Position: ADMIN
Credential:
Phone: 501-487-1903