Organization
TRIPHARMA INC
Active
Other names
Live Well Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN LYKINS (OWNER)
(479) 770-0111
Entity
Organization
Contact information
Practice address
3500 SW REGIONAL AIRPORT BLVD STE 2, BENTONVILLE, AR 72712
(479) 271-9355
(479) 770-0113
Mailing address
PO BOX 1095, GRAVETTE, AR 72736-1095
(479) 271-9355
(479) 271-9357
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
223890407
—
AR
Enumeration date
07/13/2018
Last updated
01/05/2022
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