Healthcare Provider Details

I. General information

NPI: 1699368779
Provider Name (Legal Business Name): BSRX SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2021
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9746 HIGHWAY 62 W
VIOLA AR
72583-6001
US

IV. Provider business mailing address

251 CONCORD LN
MOUNTAIN HOME AR
72653-4235
US

V. Phone/Fax

Practice location:
  • Phone: 870-900-1001
  • Fax:
Mailing address:
  • Phone: 870-378-0106
  • 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: BRETT BRANDON SHARP
Title or Position: PHARMACIST
Credential: PHARMD
Phone: 870-378-0106