Healthcare Provider Details

I. General information

NPI: 1326443573
Provider Name (Legal Business Name): SCPG ARKANSAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2014
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 W 1ST ST N
PRESCOTT AR
71857-3339
US

IV. Provider business mailing address

PO BOX 34407 PMB 53760
LITTLE ROCK AR
72203
US

V. Phone/Fax

Practice location:
  • Phone: 870-887-6664
  • Fax: 870-887-2968
Mailing address:
  • Phone: 870-887-6664
  • Fax: 870-887-2968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberAR09412
License Number StateAR

VIII. Authorized Official

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