Provider Demographics
NPI:1093751893
Name:SCA PHARMACEUTICALS, LLC
Entity Type:Organization
Organization Name:SCA PHARMACEUTICALS, LLC
Other - Org Name:SCA PHARMACEUTICALLS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GENE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-312-2800
Mailing Address - Street 1:8821 KNOEDL CT
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4600
Mailing Address - Country:US
Mailing Address - Phone:501-312-2800
Mailing Address - Fax:501-312-2805
Practice Address - Street 1:8821 KNOEDL CT
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4600
Practice Address - Country:US
Practice Address - Phone:501-312-2800
Practice Address - Fax:501-312-2805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR203963336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR154831733Medicaid
AR155042407Medicaid
AR154296716Medicaid
1989600OtherPK
5098180001Medicare NSC