Provider Demographics
NPI:1669495750
Name:SOOS COMPOUNDING CENTER
Entity type:Organization
Organization Name:SOOS COMPOUNDING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMICIST/OWNER
Authorized Official - Prefix:MRS
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:870-268-0842
Mailing Address - Street 1:512 SOUTHWEST DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-5857
Mailing Address - Country:US
Mailing Address - Phone:870-268-0842
Mailing Address - Fax:870-935-4027
Practice Address - Street 1:512 SOUTHWEST DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5857
Practice Address - Country:US
Practice Address - Phone:870-268-0842
Practice Address - Fax:870-935-4027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR202593336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR49795OtherBLUE CROSS BLUE SHEILD ID
AR49795OtherBLUE CROSS BLUE SHEILD ID
ARC08498361Medicare ID - Type UnspecifiedMEDICARE SUMMITER ID NUMB