Provider Demographics
NPI:1881670818
Name:TRIPHARMA INC
Entity Type:Organization
Organization Name:TRIPHARMA INC
Other - Org Name:LOWELL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LYKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-770-0111
Mailing Address - Street 1:PO BOX 1095
Mailing Address - Street 2:
Mailing Address - City:GRAVETTE
Mailing Address - State:AR
Mailing Address - Zip Code:72736-1095
Mailing Address - Country:US
Mailing Address - Phone:479-770-0111
Mailing Address - Fax:479-770-0113
Practice Address - Street 1:114 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:AR
Practice Address - Zip Code:72745-9047
Practice Address - Country:US
Practice Address - Phone:479-770-0111
Practice Address - Fax:479-770-0113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-21
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336H0001X
ARAR203783336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR152351407Medicaid
1989523OtherPK
AR152351407Medicaid
AR152351407Medicaid