Organization
OAK GROVE PHARMACY JFK INC
Active
Other names
Medicine Man Pharmacy JFK
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY WAYNE PERKINS PHARMD (PHARMACIST/OWNER)
(501) 940-7517
Entity
Organization
Contact information
Practice address
5308 JOHN F KENNEDY BLVD STE 3, NORTH LITTLE ROCK, AR 72116-6779
(501) 907-2095
(501) 907-2097
Mailing address
5308 JOHN F KENNEDY BLVD STE 3, NORTH LITTLE ROCK, AR 72116-6779
(501) 907-2095
(501) 907-2097
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
20695
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
196317407
—
AR
01
—
2136511
PK
—
Enumeration date
08/16/2012
Last updated
01/17/2022
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