=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952473332
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SCPG ARKANSAS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2006
-----------------------------------------------------
Last Update Date | 11/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 329 HWY 463 NORTH
-----------------------------------------------------
City | TRUMANN
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72472
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-483-6325
-----------------------------------------------------
Fax | 870-245-1790
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 34407 PMB 53760
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72203-4420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-603-7409
-----------------------------------------------------
Fax | 870-483-6483
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | UMAR FAROOQ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 501-392-8680
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 05402
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------