Organization
PEDIATRIC NUTRITION PROV OF AR
Active
Other names
ACCESS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
LEONARD GRAY PHARMD (CO OWNER)
(901) 315-7337
Entity
Organization
Contact information
Practice address
920 EDISON AVE, STE 9, BENTON, AR 72015-4502
(501) 315-7337
(501) 778-7488
Mailing address
920 EDISON AVE, STE 9, BENTON, AR 72015-4502
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
AR20528
AR
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0422357
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
06/19/2006
Last updated
09/11/2025
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