Provider Demographics
NPI:1225158777
Name:SOO'S HEALTH MART
Entity Type:Organization
Organization Name:SOO'S HEALTH MART
Other - Org Name:SOO'S DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOO
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:870-932-6930
Mailing Address - Street 1:2905 E NETTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4534
Mailing Address - Country:US
Mailing Address - Phone:870-932-6930
Mailing Address - Fax:870-932-1378
Practice Address - Street 1:2905 E NETTLETON AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4534
Practice Address - Country:US
Practice Address - Phone:870-932-6930
Practice Address - Fax:870-932-1378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR20121332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies