Healthcare Provider Details

I. General information

NPI: 1104184332
Provider Name (Legal Business Name): SCPG ARKANSAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 EAST WALNUT STEET
PARIS AR
72855
US

IV. Provider business mailing address

PO BOX 34407 PMB 53760
LITTLE ROCK AR
72203-4420
US

V. Phone/Fax

Practice location:
  • Phone: 479-963-6400
  • Fax: 479-963-2103
Mailing address:
  • Phone: 501-603-7409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberAR20671
License Number StateAR

VIII. Authorized Official

Name: UMAR FAROOQ
Title or Position: PRESIDENT
Credential:
Phone: 501-392-8680