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General NPI Number Information
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NPI Number | 1669495750
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Entity Type | Organization
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Legal Business Name | SOOS COMPOUNDING CENTER
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 512 SOUTHWEST DR
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City | JONESBORO
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State | AR
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Zip | 72401-5857
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Country | US
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Telephone | 870-268-0842
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Fax | 870-935-4027
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Provider Business Mailing Address
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Address Line | 512 SOUTHWEST DR
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City | JONESBORO
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State | AR
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Zip | 72401-5857
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Country | US
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Telephone | 870-268-0842
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Fax | 870-935-4027
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Authorized Official
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Title or Position | PHARMICIST/OWNER
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Name | MRS. MICHAEL ALAN SOO
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Credential | PD
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Telephone | 870-268-0842
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | AR20259
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License Number State | AR
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