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General NPI Number Information
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NPI Number | 1790116523
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Entity Type | Organization
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Legal Business Name | SOUTHEAST ARKANSAS PHARMACIES LLC
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Dates
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Enumeration Date | 12/04/2013
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Last Update Date | 12/09/2014
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Provider Practice Location Address
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Address Line | 539 HIGHWAY 425 S
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City | MONTICELLO
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State | AR
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Zip | 71655-4674
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Country | US
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Telephone | 870-367-4227
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Fax | 870-367-4211
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Provider Business Mailing Address
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Address Line | PO BOX 1012
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City | MONTICELLO
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State | AR
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Zip | 71657-1012
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Country | US
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Telephone | 870-367-4227
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Fax | 870-367-4211
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Authorized Official
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Title or Position | OWNER/PHARMACIST IN CHARGE
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Name | BRIAN SMITH
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Credential |
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Telephone | 870-460-5201
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | AR20742
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License Number State | AR
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