Soos Drug Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

AR20121 Issued in AR

Legal business name

SOOS DRUG INC

Doing business as

Soo's Drug Store

Practice address

2822 E Nettleton Ave
Jonesboro, AR 72401-4531

Phone

(870) 932-6930

Fax

(870) 932-1378

NPI assigned

Jul 27, 2005

Last updated

Mar 2, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Tyler Alan Soo, PHARMDNPI 1942727730

Title

Owner/Pharmacist

Phone

(870) 932-6930

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• SOO'S DRUG STORE Doing business as

Medicare fee-for-service enrollment

Enrolled in AR2 enrollments

Enrollment records 2

Tax ID family

Soo's Drug Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Soos Drug Inc

  dba Soo's Drug Store Long Term Care

  • Long Term Care Pharmacy
  • Jonesboro, AR
  • NPI 1013605203
  NPD tax ID

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tyler Alan Soo, PHARM.D

  • Pharmacist
  • Jonesboro, AR
  • NPI 1942727730
  Authorized official Same address or phone
• Krystal Soo, PHARM.D.

  • Pharmacist
  • Jonesboro, AR
  • NPI 1366596124
  NPD
• Tedie Hayes, PHARM.D

  • Pharmacist
  • Jonesboro, AR
  • NPI 1164616868
  NPD (past)
• Andrea R. Rubottom, PHARM.D.

  • Pharmacist
  • Jonesboro, AR
  • NPI 1497890297
  NPD (past)

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

{
    "created_epoch": "1122422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614643200000",
    "number": "1497755946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2822 E NETTLETON AVE",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724014531",
            "telephone_number": "870-932-6930",
            "fax_number": "870-932-1378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2822 E NETTLETON AVE",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724014531",
            "telephone_number": "870-932-6930",
            "fax_number": "870-932-1378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOOS DRUG INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-27",
        "last_updated": "2021-03-02",
        "certification_date": "2021-03-02",
        "status": "A",
        "authorized_official_last_name": "SOO",
        "authorized_official_first_name": "TYLER",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "OWNER/PHARMACIST",
        "authorized_official_telephone_number": "870-932-6930",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AR",
            "license": "AR20121",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "133719407",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "1992995",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOO'S DRUG STORE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SOO'S DRUG STORE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michael Alan Soo, PD
• Tyler Alan Soo, PHARM.D
• Soo's Health Mart (Soo's Drug)
• Soos Compounding Center
• Soos Drug Inc (Soo's Drug Store Long Term Care)
• Aundrea Souders, R.N.
• Soul Purpose Wellness Center, LLC
• Ronald E South, M.D.
• Casey Ann Southard, RN
• Heather Bond Southard, DDS

• Community/Retail Pharmacy in Jonesboro, AR
• Providers in Jonesboro, AR by specialty
• Community/Retail Pharmacy in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.