Provider Demographics
NPI:1790116523
Name:SOUTHEAST ARKANSAS PHARMACIES LLC
Entity Type:Organization
Organization Name:SOUTHEAST ARKANSAS PHARMACIES LLC
Other - Org Name:THE PRESCRIPTION PAD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-460-5201
Mailing Address - Street 1:PO BOX 1012
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71657-1012
Mailing Address - Country:US
Mailing Address - Phone:870-367-4227
Mailing Address - Fax:870-367-4211
Practice Address - Street 1:539 HIGHWAY 425 S
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-4674
Practice Address - Country:US
Practice Address - Phone:870-367-4227
Practice Address - Fax:870-367-4211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-04
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
ARAR207423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2144706OtherPK
AR7237170001Medicare NSC