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General NPI Number Information
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NPI Number | 1891731410
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Entity Type | Organization
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Legal Business Name | STATE OF ARKANSAS
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Dates
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Enumeration Date | 06/21/2006
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Last Update Date | 06/17/2016
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Provider Practice Location Address
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Address Line | 305 S PALM ST
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City | LITTLE ROCK
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State | AR
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Zip | 72205-5432
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Country | US
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Telephone | 501-686-9047
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Fax | 507-686-9669
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Provider Business Mailing Address
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Address Line | 305 S PALM ST
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City | LITTLE ROCK
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State | AR
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Zip | 72205-5432
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Country | US
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Telephone | 501-686-9048
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Fax | 507-686-9669
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Authorized Official
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Title or Position | HOSPITAL ADMINISTRATOR
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Name | STEVEN HENSON
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Credential | PD
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Telephone | 501-251-6400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336I0012X
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Taxonomy Name | Institutional Pharmacy
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License Number | HP00020
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License Number State | AR
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