Provider Demographics
NPI:1477998847
Name:UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES
Entity type:Organization
Organization Name:UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/340B PROGRAM
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMO
Authorized Official - Middle Name:C
Authorized Official - Last Name:STINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-364-1494
Mailing Address - Street 1:1 CHILDRENS WAY # 512-10
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-3500
Mailing Address - Country:US
Mailing Address - Phone:501-364-1494
Mailing Address - Fax:501-526-6562
Practice Address - Street 1:1 CHILDRENS WAY # 512-10
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3500
Practice Address - Country:US
Practice Address - Phone:501-364-1494
Practice Address - Fax:501-526-6562
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy