Provider Demographics
NPI:1144301136
Name:ACCESS PHARMACY
Entity type:Organization
Organization Name:ACCESS PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:501-315-2025
Mailing Address - Street 1:920 EDISON AVE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-4502
Mailing Address - Country:US
Mailing Address - Phone:501-315-2025
Mailing Address - Fax:501-315-1034
Practice Address - Street 1:920 EDISON AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-4502
Practice Address - Country:US
Practice Address - Phone:501-315-2025
Practice Address - Fax:501-315-1034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR205283336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0422357OtherNCPDP
AR4673130001Medicare ID - Type Unspecified