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General NPI Number Information
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NPI Number | 1053669325
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Entity Type | Organization
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Legal Business Name | OAK GROVE PHARMACY JFK INC
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Dates
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Enumeration Date | 08/16/2012
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Last Update Date | 01/17/2022
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Provider Practice Location Address
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Address Line | 5308 JOHN F KENNEDY BLVD STE 3
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72116-6779
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Country | US
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Telephone | 501-907-2095
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Fax | 501-907-2097
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Provider Business Mailing Address
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Address Line | 5308 JOHN F KENNEDY BLVD STE 3
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72116-6779
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Country | US
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Telephone | 501-907-2095
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Fax | 501-907-2097
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | TERRY WAYNE PERKINS
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Credential | PHARMD
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Telephone | 501-940-7517
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 20695
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License Number State | AR
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