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General NPI Number Information
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NPI Number | 1578274106
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Entity Type | Organization
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Legal Business Name | LUKE PILL LLC
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Dates
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Enumeration Date | 12/05/2022
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Last Update Date | 01/13/2023
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Provider Practice Location Address
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Address Line | 901 JOHN BARROW RD
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City | LITTLE ROCK
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State | AR
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Zip | 72205-6503
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Country | US
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Telephone | 501-604-8008
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Fax | 501-604-8009
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Provider Business Mailing Address
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Address Line | 113 BLACKBURN DR
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City | LITTLE ROCK
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State | AR
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Zip | 72211-2168
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Country | US
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Telephone | 717-319-4033
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Fax | 501-604-8009
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE / OWNER
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Name | BOLA SIDAROUS
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Credential | RPH
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Telephone | 717-319-4033
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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 |
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License Number State |
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