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Pediatric Nutrition Prov Of Ar
Long Term Care Pharmacy in Benton, Arkansas
NPI 1477598795

Pediatric Nutrition Prov Of Ar is a Long Term Care Pharmacy based in Benton, AR and is specialized in Long Term Care Pharmacy. Pediatric Nutrition Prov Of Ar practices in Benton, AR. The NPI Number for Pediatric Nutrition Prov Of Ar is 1477598795 and holds a License No. AR20528 (Arkansas).

The current practice location address for Pediatric Nutrition Prov Of Ar is 920 Edison Ave, Benton, AR and can be reached out via phone at 501-315-7337 and via fax at 501-778-7488.

Location: 920 Edison Ave, Benton, AR, 72015-4502
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1477598795
Provider Name
Pediatric Nutrition Prov Of Ar
Credential
Provider Entity Type
Organization
Address
920 Edison Ave, Benton, AR, 72015-4502
Phone Number
501-315-7337
Fax Number
501-778-7488
Provider Enumeration Date
06/19/2006
Last Update Date
02/15/2025
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Provider's Legacy Identifiers
Identifier Type State Issuer
0422357 01 OTHER ID NUMBER-COMMERCIAL NUMBER
institution
Provider Business Practice Location Address Details
Address
920 Edison Ave
City
Benton
State
Arkansas
Zip
72015-4502
Phone Number
501-315-7337
Fax Number
501-778-7488
person
Provider Business Mailing Address Details
Address
920 Edison Ave
City
Benton
State
Arkansas
Zip
72015-4502
Phone Number
501-315-7337
Fax Number
501-778-7488
person
Provider's Taxonomy Details 1
Type
Suppliers
Classification
Pharmacy
Speciality
-
Taxonomy
333600000X
License No.
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Definition
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.
person
Provider's Taxonomy Details 2
Type
Suppliers
Classification
Pharmacy
Speciality
Long Term Care Pharmacy
Taxonomy
3336L0003X
License No.
AR20528 (Arkansas)
Definition
A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities for mentally retarded, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements.
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