Pediatric Nutrition Prov Of Ar
Pharmacy, Long Term Care Pharmacy in Benton, AR. Organization (NPI-2).
NPI number1477598795
StatusActive
Last updated in NPPESSep 11, 2025
Details
- NPI
- 1477598795
- Entity type
- Organization (NPI-2)
- Legal business name
- Pediatric Nutrition Prov Of Ar
- Organization subpart
- No
- Enumeration date
- Jun 19, 2006
- Last updated
- Sep 11, 2025
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 3336L0003X | Pharmacy, Long Term Care Pharmacy | – | – | Yes |
| 333600000X | Pharmacy | AR20528 | AR |
Other names
- Access Pharmacy (Doing Business As)
Practice location
920 Edison AveSte 9
Benton, AR 72015-4502
Phone 501-315-7337 · Fax 501-778-7488
Mailing address
920 Edison AveSte 9
Benton, AR 72015-4502
Authorized official
Leonard Gray
Co Owner
9013157337
Is something wrong?
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All 6 Long Term Care Pharmacy providers in Benton · All 2,212 providers in Benton
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