Healthcare Provider Details

I. General information

NPI: 1801428495
Provider Name (Legal Business Name): SCPG MISSOURI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SOUTH MADISON AVE, SUITE S
WEBB CITY MO
64870
US

IV. Provider business mailing address

PO BOX 34407 PMB 53760
LITTLE ROCK AR
72203
US

V. Phone/Fax

Practice location:
  • Phone: 501-258-4399
  • Fax:
Mailing address:
  • Phone: 501-258-4399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

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