=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376341842
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARCH STREET RX, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2025
-----------------------------------------------------
Last Update Date | 03/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11200 ARCH ST
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72206-4649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-261-7181
-----------------------------------------------------
Fax | 501-475-0398
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 26690
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72221-6621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-261-7181
-----------------------------------------------------
Fax | 501-475-0398
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. KENNY HARRISON
-----------------------------------------------------
Credential | PHARM D
-----------------------------------------------------
Telephone | 501-580-1895
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------