Provider Demographics
NPI:1952473332
Name:SCPG ARKANSAS LLC
Entity Type:Organization
Organization Name:SCPG ARKANSAS LLC
Other - Org Name:EXPRESS RX OF TRUMANN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GALEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-259-4399
Mailing Address - Street 1:PO BOX 34407 PMB 53760
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72203-4420
Mailing Address - Country:US
Mailing Address - Phone:501-603-7409
Mailing Address - Fax:870-483-6483
Practice Address - Street 1:329 HWY 463 NORTH
Practice Address - Street 2:
Practice Address - City:TRUMANN
Practice Address - State:AR
Practice Address - Zip Code:72472
Practice Address - Country:US
Practice Address - Phone:870-483-6325
Practice Address - Fax:870-245-1790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR054023336C0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0415655OtherNABP
AR205422407Medicaid
AR114174407Medicaid
AR114174407Medicaid