MEDICARE: INFANT FORMULAS INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	0000000453	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710918164
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFANT FORMULAS INC.

Provider Business Mailing Address
First Line	:	7625 COUNTS MASSIE RD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72113-6656
Country	:	US
Telephone Number	:	501-753-3330
Fax Number	:	501-753-9378

Provider Business Practice Location Address
First Line	:	7625 COUNTS MASSIE RD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72113-6656
Country	:	US
Telephone Number	:	501-753-3330
Fax Number	:	501-753-9378

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JEFF PETTIT
Credential	:
Telephone Number	:	501-753-3330

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	08/06/2025

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