Provider Demographics
NPI:1477694594
Name:PSI ARKANSAS ACQUISITION, LLC
Entity Type:Organization
Organization Name:PSI ARKANSAS ACQUISITION, LLC
Other - Org Name:PHARMACY SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGULATORY LICENSING MANGAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-719-2600
Mailing Address - Street 1:201 E 4TH ST
Mailing Address - Street 2:900 OMNICARE CENTER
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-4248
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2125 COLLEGE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-6210
Practice Address - Country:US
Practice Address - Phone:501-764-1414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
0421278OtherNCPDP
AR165041407Medicaid