Healthcare Provider Details

I. General information

NPI: 1457978157
Provider Name (Legal Business Name): SC PHARMACY GROUP OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 RIVERFRONT DR STE 100
LITTLE ROCK AR
72202-1882
US

IV. Provider business mailing address

PO BOX 34407 PMB 53760
LITTLE ROCK AR
72203-4416
US

V. Phone/Fax

Practice location:
  • Phone: 501-534-4459
  • Fax:
Mailing address:
  • Phone: 501-534-4459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GALEN PERKINS
Title or Position: CEO
Credential: PHARMD
Phone: 501-258-4399