Provider Information for 1578995007
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SCPG ARKANSAS LLC
Other Names:Doing Business As:EXPRESS RX OF PINE BLUFFOrganization Subpart: NO
NPI: 1578995007
Last Updated: 2021-01-19
Certification Date: 2021-01-19
Certification Date: 2021-01-19
Details
| Name | Value | ||||||||||||||||
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| NPI | 1578995007 | ||||||||||||||||
| Enumeration Date | 2013-08-07 | ||||||||||||||||
| NPI Type | NPI-2 Organization | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Authorized Official Information | Name: GALEN PERKINS Title: CEO Phone: 5012594399 | ||||||||||||||||
| Mailing Address | PO BOX 34407 PMB 53760 LITTLE ROCK, AR 72203-4420 United States Phone: 501-603-7409 | Fax:870-245-1790 | ||||||||||||||||
| Primary Practice Address | 3006 WEST 28TH AVENUE PINE BLUFF, AR 71603 United States Phone: 870-850-0159 | Fax:870-850-0177 | ||||||||||||||||
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