# PEDIATRIC NUTRITION PROV OF AR

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ACCESS PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477598795
- **Authorized official:** LEONARD GRAY PHARMD (CO OWNER)
- **Authorized official phone:** (901) 315-7337

## Contact information

- **Practice address:** 920 EDISON AVE, STE 9, BENTON, AR 72015-4502
- **Practice address phone:** (501) 315-7337
- **Practice address fax:** (501) 778-7488
- **Mailing address:** 920 EDISON AVE, STE 9, BENTON, AR 72015-4502

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | AR20528 | AR | — |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 06/19/2006
- **Last updated:** 09/11/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0422357 | OTHER ID NUMBER-COMMERCIAL NUMBER | — |