SOUTHERN PHARMACY OF ARKANSAS NPI 1366453946

Pharmacy - Community/Retail Pharmacy in Monette, AR

Organization Pharmacy Community/Retail Pharmacy Medicare Supplier Accepts Medicare Approved Payment CLIA Number 04D2154512 CLIA Certificate of Waiver

About SOUTHERN PHARMACY OF ARKANSAS

Southern Pharmacy Of Arkansas is a provider established in Monette, Arkansas specializing in Pharmacy with a focus in community/retail pharmacy . The NPI number of Southern Pharmacy Of Arkansas is 1366453946 and was assigned on August 2006. The practitioner's primary taxonomy code is 3336C0003X with license number AR17344 (AR). The provider is registered as an organization and their NPI record was last updated 2 years ago. The provider's is doing business as Southern Pharmacy Of Arkansas. The authorized official of this NPI record is Dr. Kyle Andrew Lomax Pharm. D (President)

The CLIA number of Southern Pharmacy Of Arkansas is 04D2154512 registered as a "pharmacy" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to Southern Pharmacy Of Arkansas to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

NPI

1366453946

Provider NameSOUTHERN PHARMACY OF ARKANSAS
Provider Location Address214 W DREW AVE MONETTE, AR 72447
Provider Mailing Address3001 APACHE DR JONESBORO, AR 72401
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Other Organization NameSOUTHERN PHARMACY OF ARKANSAS
Other Name TypeDoing Business As (3)
Enumeration Date08-10-2006
Last Update Date10-05-2020



Southern Pharmacy Of Arkansas is a medicare supplier with PTAN 3912670001 who accepts Medicare assignment for all durable medical equipment and supplies. The provider accepts the Medicare allowable as payment in full.The supplier carries the following product categories: Epoetin or Immunosuppressive Drugs or Infusion Drugs or Nebulizer Drugs or Oral Anticancer Drugs or Oral Antiemetic Drugs or Commodes, Urinals, Bedpans or Canes and/or Crutches or Walkers or Orthoses: Off-The-Shelf or Ostomy Supplies or Urological Supplies or Nebulizer Equipment and/or Supplies or Surgical Dressings.



Primary Taxonomy

Taxonomy Code3336C0003X
ClassificationPharmacy
TypeSuppliers
SpecializationCommunity/Retail Pharmacy
License No.AR17344
License StateAR
Taxonomy DescriptionA pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

Business Address

SOUTHERN PHARMACY OF ARKANSAS
214 W DREW AVE
MONETTE, AR
ZIP 72447
Phone: (870) 486-2111
Fax: (870) 486-2565

Get Directions


Mailing Address

SOUTHERN PHARMACY OF ARKANSAS
3001 APACHE DR
JONESBORO, AR
ZIP 72401
Phone: (870) 275-9496
Fax: (870) 931-0992


Authorized Official

Authorized Official NameDR. KYLE ANDREW LOMAX PHARM. D
Authorized Official TitlePRESIDENT
Authorized Official Phone(870) 275-9496

Medical Equipment Supplier

The provider carries the following medical supplies product categories:

PTAN3912670001
Accepts Medicare AssignmentYES
Specialities ListCertified Other, Pharmacy.
Supplies List
  • Epoetin - Epoetin is a man-made version of human erythropoietin (EPO)
  • Immunosuppressive Drugs - Immunosuppressive drugs require dosage, frequency, and route of administration to prevent or treat the rejection of an organ transplant
  • Infusion Drugs -
  • Nebulizer Drugs - Albuterol, levalbuterol, and metaproterenol are all short-acting bronchodilators with beta-adrenergic stimulatory effect
  • Oral Anticancer Drugs - FDA anticancer drugs
  • Oral Antiemetic Drugs - FDA antiemetic drugs
  • Commodes, Urinals, Bedpans - Raised toilets, Drop-arm commodes, Folding commodes, Plastic urinals, Plastic bedpans, Disposable urinals
  • Canes and/or Crutches - Standard Canes, Quad Canes, Offset Canes, Standard Crutches, Forearm Crutches
  • Walkers - Standard Walkers, Wheeled Walkers, Folding Walker
  • Orthoses: Off-The-Shelf - Met pads, Heel pads, Heel spur pads
  • Ostomy Supplies - Pouches, Paste, Powder, Barrier wipes
  • Urological Supplies - Catheters, Urinary collection devices
  • Nebulizer Equipment and/or Supplies - Nebulizers, Atomizers, Filters
  • Surgical Dressings - Gauze, Elastic bandages, Adhesive tape
Competitive BiddingNO

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1366453946 is:

CLIA Number04D2154512
Facility TypePHARMACY
Certificate TypeCertificate of Waiver

Secondary Taxonomies


The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.

No. Taxonomy Code Type Classification Specialization License No. State Primary
1332B00000XSuppliersDurable Medical Equipment & Medical SuppliesNo

Taxonomy Description: a supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

2333600000XSuppliersPharmacyNo

Taxonomy Description: a facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

33336L0003XSuppliersPharmacyLong Term Care PharmacyNo

Taxonomy Description: 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.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State Identifier Issuer
0417344OTHER (01)NCPDP
AR17344OTHER (01)ARARKANSAS PHARMACY PERMIT

NPI Validation Check Digit Calculation


The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1366453946
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2312685698
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 3 + 1 + 2 + 6 + 8 + 5 + 6 + 9 + 8 + 24 = 74
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
80 - 74 = 66

The NPI number 1366453946 is valid because the calculated check digit 6 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the same location


The following provider is registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1851771711DR. KACEY KILLEBREW PHARMD
Individual
Pharmacist214 W DREW AVE
MONETTE, AR 72447
(870) 486-2111

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
Southern Pharmacy Of Arkansas is registered as an entity type code: 2. The entity type code describes the type of health care provider that is being assigned an NPI. The entity type codes are:

  • 1 = Person: individual human being who furnishes health care.
  • 2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.