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General NPI Number Information
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NPI Number | 1528463775
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Entity Type | Organization
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Legal Business Name | SCPG ARKANSAS LLC
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Dates
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Enumeration Date | 10/30/2014
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Last Update Date | 01/15/2021
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Provider Practice Location Address
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Address Line | 3006 W 28TH AVE
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City | PINE BLUFF
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State | AR
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Zip | 71603-4803
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Country | US
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Telephone | 870-850-0159
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Fax | 870-850-0177
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Provider Business Mailing Address
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Address Line | PO BOX 34407 PMB 53760
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City | LITTLE ROCK
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State | AR
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Zip | 72203-0524
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Country | US
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Telephone | 870-850-0159
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Fax | 870-850-0177
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Authorized Official
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Title or Position | CEO
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Name | GALEN PERKINS
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Credential |
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Telephone | 870-850-0159
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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 | AR20725
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License Number State | AR
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