| NPI | 1992809560 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KHALIL L CROUSE Manager 870-265-2220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies (Licence: AR AR-20331) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AR AR-20331) |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: AR AR-20331) | |
| 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition (Licence: AR AR-20331) | |
| 333600000X Pharmacy (Licence: AR AR-20331) | |
| 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: AR AR-20331) | |
| 3336H0001X Pharmacy, Home Infusion Therapy Pharmacy (Licence: AR AR-20331) | |
| 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: AR AR-20331) | |
| 3336M0002X Pharmacy, Mail Order Pharmacy (Licence: AR AR-20331) | |
| 3336S0011X Pharmacy, Specialty Pharmacy (Licence: AR AR-20331) | |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2016-02-12 |