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General NPI Number Information
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NPI Number | 1093858698
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Entity Type | Organization
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Legal Business Name | KAVANAUGH PHARMACY
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 5008 KAVANAUGH BLVD
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City | LITTLE ROCK
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State | AR
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Zip | 72207-4747
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Country | US
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Telephone | 501-664-3844
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Fax |
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Provider Business Mailing Address
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Address Line | 5008 KAVANAUGH BLVD
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City | LITTLE ROCK
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State | AR
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Zip | 72207-4747
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Country | US
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Telephone | 501-664-3844
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Fax |
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Authorized Official
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Title or Position | PHARMACIST-IN-CHARGE
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Name | THOMAS GREGORY COOPER
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Credential | P.D.
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Telephone | 501-664-3844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | AR04183
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License Number State | AR
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