Provider Demographics
NPI:1497755946
Name:SOOS DRUG INC
Entity Type:Organization
Organization Name:SOOS DRUG INC
Other - Org Name:SOO'S DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SOO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:870-932-6930
Mailing Address - Street 1:2822 E NETTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4531
Mailing Address - Country:US
Mailing Address - Phone:870-932-6930
Mailing Address - Fax:870-932-1378
Practice Address - Street 1:2822 E NETTLETON AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4531
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:2005-07-27
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
ARAR201213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR133719407Medicaid
1992995OtherPK
AR133719407Medicaid