Healthcare Provider Details

I. General information

NPI: 1962026583
Provider Name (Legal Business Name): SJD PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2806 E RACE AVE
SEARCY AR
72143-4776
US

IV. Provider business mailing address

2806 E RACE AVE
SEARCY AR
72143-4776
US

V. Phone/Fax

Practice location:
  • Phone: 501-268-4121
  • Fax: 501-268-7837
Mailing address:
  • Phone: 501-268-4121
  • Fax: 501-268-7837

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: STEVEN DAVIS
Title or Position: OWNER
Credential:
Phone: 501-268-4121