Healthcare Provider Details

I. General information

NPI: 1932271590
Provider Name (Legal Business Name): ROACH ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 09/19/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 HIGHWAY 63B STE A SUITE A
MARKED TREE AR
72365-1614
US

IV. Provider business mailing address

98 HIGHWAY 63B STE A SUITE A
MARKED TREE AR
72365-1614
US

V. Phone/Fax

Practice location:
  • Phone: 870-358-2484
  • Fax: 870-358-6337
Mailing address:
  • Phone: 870-358-2484
  • Fax:

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 TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberAR20314
License Number StateAR

VIII. Authorized Official

Name: DONNI ROACH
Title or Position: PRESIDENT
Credential: B.S. PHARMACY
Phone: 870-358-2484