NPIMap

Organization Active NPI

Pediatric Nutrition Prov of Ar

  • Long Term Care Pharmacy
  • Benton, AR
National Provider Identifier
1477598795
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
PEDIATRIC NUTRITION PROV OF AR
Practice address
920 Edison Ave
Ste 9
Benton, AR 72015-4502
Phone
(501) 315-7337
Fax
(501) 778-7488
NPI assigned
Jun 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Leonard Gray, PHARMD
Title
Co Owner
Phone
(901) 315-7337

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X AR20528 AR
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

920 Edison Ave
Ste 9
Benton, AR 72015-4502

Mailing address

920 Edison Ave
Ste 9
Benton, AR 72015-4502

Other identifiers 1

IdentifierTypeStateIssuer
0422357OtherOTHER ID NUMBER-COMMERCIAL NUMBER

Other names 1

  • ACCESS PHARMACY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Access Pharmacy5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1477598795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 EDISON AVE",
            "address_2": "STE 9",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720154502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 EDISON AVE",
            "address_2": "STE 9",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720154502",
            "telephone_number": "501-315-7337",
            "fax_number": "501-778-7488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC NUTRITION PROV OF AR",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-19",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "LEONARD",
        "authorized_official_title_or_position": "CO OWNER",
        "authorized_official_telephone_number": "901-315-7337",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "AR",
            "license": "AR20528",
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "0422357",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ACCESS PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Benton, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.