Provider Demographics
NPI:1265786354
Name:NEA PHARMACEUTICALS
Entity type:Organization
Organization Name:NEA PHARMACEUTICALS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACISTS
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SOO
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:870-935-6400
Mailing Address - Street 1:1109 W. PARKER ROAD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-9583
Mailing Address - Country:US
Mailing Address - Phone:870-935-6400
Mailing Address - Fax:870-935-4027
Practice Address - Street 1:1109 W. PARKER ROAD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-9583
Practice Address - Country:US
Practice Address - Phone:870-935-6400
Practice Address - Fax:870-935-4027
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEA PHARMACEUTICALS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-29
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR038023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5721580001Medicare NSC