Pediatric Nutrition Prov Of Ar
Long Term Care Pharmacy
920 Edison Ave, Ste 9, Benton
Arkansas, 72015-4502
501-315-7337 501-778-7488
Pediatric Nutrition Prov Of Ar is a Long Term Care Pharmacy in Benton, Arkansas. It is located at 920 Edison Ave, Ste 9, Benton and it's customer support contact number is 501-315-7337. The authorized person of Pediatric Nutrition Prov Of Ar is Leonard Gray, PHARMD who is Co Owner of the pharmacy and his contact number is 901-315-7337.
Pediatric Nutrition Prov Of Ar is a pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities for mentally retarded, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements.
Pharmacy Details:
Pediatric Nutrition Prov Of Ar type, location, contact phone number and fax are as below. Patients can directly walkin to the pharmacy or can call on the below given customer support phone number for enquiries.
| Name: | Pediatric Nutrition Prov Of Ar |
| Type: | Long Term Care Pharmacy |
| Location: | 920 Edison Ave, Ste 9, Benton,
Arkansas, 72015-4502 |
| Phone: | 501-315-7337 |
| Fax: | 501-778-7488 |
Authorized/Official Person Profile:
Officially authorized person to contact for any management issues or complaints of this pharmacy is as below. Person's position and contact details are also mentioned below.
| Name: | Leonard Gray |
| Credentials: | PHARMD |
| Position: | Co Owner |
| Contact Number: | 901-315-7337 |
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details of given pharmacy are as mentioned below.
| NPI Number: | 1477598795 |
| NPI Enumeration Date: | 19 Jun, 2006 |
| NPI Last Update On: | 11 Sep, 2025 |
Medical Licenses:
Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Pediatric Nutrition Prov Of Ar are as mentioned below.
| Specialization | License Number | State | Status | |
| Long Term Care Pharmacy | | | Primary | |
| Pharmacy | AR20528 | Arkansas | Secondary | |
Other Medical Identifiers:
Other legacy medical identifiers of the pharmacy such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned as below.
| Identifier | Type | State | Issuer |
| 0422357 | Other | | Other Id Number-commercial Number |
Business Mailing Address:
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
| Address: | 920 Edison Ave, Ste 9
Benton, Arkansas |
| Zip: | 72015-4502 |
| Phone Number: | -- |
Patients can reach Pediatric Nutrition Prov Of Ar at
920 Edison Ave, Ste 9, Benton, Arkansas or can
call on customer care at 501-315-7337.
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**Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 08 December, 2025.