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General NPI Number Information
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NPI Number | 1093861825
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Entity Type | Organization
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Legal Business Name | HIGHLANDS ONCOLOGY GROUP, PA
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 08/02/2021
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Provider Practice Location Address
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Address Line | 3232 N NORTH HILLS BLVD
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-4005
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Country | US
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Telephone | 479-695-1199
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Fax | 479-695-1214
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Provider Business Mailing Address
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Address Line | 3232 N NORTH HILLS BLVD
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-4005
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Country | US
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Telephone | 479-695-1199
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Fax | 479-695-1214
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Authorized Official
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Title or Position | PHARMACIST
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Name | KYLE P COOK
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Credential | RPH
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Telephone | 479-695-1199
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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 | AR20554
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License Number State | AR
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