19TH MDSS SGSR (NPI# 1841399888) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841399888 |
| Entity Type | Organization |
| Organization Name | 19TH MDSS SGSR |
| Other Organization Name | LITTLE ROCK REFILL PHCY |
| Practice Address |
1090 Arnold Dr Little Rock Afb AR 72099-4933 |
| Practice Telephone | 5019878981 |
| Practice Fax Number | 5019877605 |
| Mailing Telephone | 5019878981 |
| Mailing Fax Number | 5019877605 |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2016-03-30 |
| Authorized Official Name | HECTOR MORALES (CHIEF DHA PASS) |
| Authorized Official Telephone | 2105366650 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332000000X | Military/U.S. Coast Guard Pharmacy | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 1989352 | 01 |
| Other Name | Type Code |
|---|---|
| LITTLE ROCK REFILL PHCY | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104989763 | 19th Mdss Sgsr | Military/U.S. Coast Guard Pharmacy | 1090 Arnold Dr Bldg 1090, Little Rock Afb, AR 72099-4933 | 2006-12-18 |
| 1841606936 | 19th Mdss Sgsr | Pharmacy | 1090 Arnold Dr, Little Rock Afb, AR 72099-4933 | 2014-07-09 |
| 1932208972 | 19th Mdss Sgsr | Military/U.S. Coast Guard Pharmacy | 1090 Arnold Dr, Little Rock Afb, AR 72099-4933 | 2006-09-22 |
| 1073591830 | 19th Mdss Sgsr | Military/U.S. Coast Guard Pharmacy | 1090 Arnold Dr, Lr Afb, AR 72099-4933 | 2006-01-03 |
| Street Address |
1090 ARNOLD DR |
| City | LITTLE ROCK AFB |
| State | AR |
| Zip Code | 72099-4933 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558353524 | Ruth Paula Gullotta | Pediatrics | 1090 Arnold Dr, Little Rock Afb, AR 72099-4933 | 2005-08-16 |
| 1669087961 | Franko Salazar | Physician Assistant | 1090 Arnold Dr, Little Rock Afb, AR 72099-4933 | 2020-09-14 |
| 1023642840 | Cara D Roth | Social Worker | 1090 Arnold Dr, Little Rock Afb, AR 72099-4933 | 2020-03-02 |
| 1154971513 | Timothy Ryan Southerland | Psychologist | 1090 Arnold Dr, Little Rock Afb, AR 72099-4933 | 2019-09-18 |
| 1407409428 | Jenisha Rae Mermis | Military Health Care Provider | 1090 Arnold Dr, Little Rock Afb, AR 72099-4933 | 2019-07-18 |
| 1457810848 | Dennis Dale Jackson II | Pharmacist | 1090 Arnold Dr, Little Rock Afb, AR 72099 | 2019-03-15 |
| 1053877902 | Chase Andrew Cannon | Physician Assistant | 1090 Arnold Dr, Little Rock Afb, AR 72099-2502 | 2019-02-15 |
| 1235600461 | Leeanne Elizabeth Ogle | Military Health Care Provider | 1090 Arnold Dr, Little Rock Afb, AR 72099-4933 | 2018-12-16 |
| 1972078004 | Meghan Rachelle Dailey | Physician Assistant | 1090 Arnold Dr, Little Rock Afb, AR 72099-1043 | 2018-10-04 |
| 1760977979 | Lashica Davis | Pharmacist | 1090 Arnold Dr, Little Rock Afb, AR 72099-4933 | 2018-06-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356876577 | Little Rock Air Force Base Eye Care | Optometrist | 6th Street, Bldg 787, Little Rock Air Force Base, Little Rock, AR 72099 | 2017-04-25 |
| 1841636206 | National Vision Optical | Technician/Technologist | Bldg 787 6th St., Little Rock, AR 72099 | 2013-05-13 |
| 1134341076 | Keisha Denythia Henry | Psychologist | 314 Medical Group, Life Skills Support Center, 1090 Arnold Drive, Little Rock Afb, AR 72099 | 2007-05-02 |
| 1699213454 | Teryn Ardell Freeman | Physician Assistant | 19th Medical Group, 1090 Arnold Drive, Little Rock, AR 72099 | 2017-02-01 |
| 1730314899 | Andrew Chichick Iv | Military Health Care Provider | 1090 Arnold Drive, 19 Amds/sgpf, Little Rock Afb, AR 72099 | 2009-05-19 |
| 1427316488 | Sunland Optical Co., Inc. | Eyewear Supplier (Equipment, not the service) | 6 Th St Bldg 787, Little Rock Afb, AR 72099-0001 | 2012-04-27 |
| 1700174828 | Lewis Mark Wiggins | Family Medicine | 19th Medical Group, Jacksonville, AR 72099-0001 | 2011-07-11 |
| 1104052158 | Seth Thomas Tolliver | Nurse Practitioner | 101 Master Sergeant Dan Wassom, Little Rock Afb, AR 72099-0001 | 2009-06-04 |
| 1316171994 | Jeff J. Sandoval | Military Health Care Provider | 19 Amds Sgopf, 1090 Arnold Dr, Little Rock Afb, AR 72099-0001 | 2009-05-11 |
| 1366610198 | Robert Anthony Olivi Jr. | Physician Assistant | 19th Medical Group 1090 Arnold Drive, Little Rock Air Force Base, AR 72099-0001 | 2008-02-14 |
| Find all providers in zip 72099 | ||||
| Taxonomy Code | 332000000X |
| Grouping | Suppliers |
| Classification | Military/U.S. Coast Guard Pharmacy |
| A Department of Defense (DoD) or U.S. Coast Guard entity whose primary function is to store, prepare and dispense pharmaceuticals and other associated items to Uniformed Services beneficiaries. These pharmacies may be associated with a DoD or U.S. Coast Guard clinic, DoD Hospital or freestanding. Usually associated with outpatient services. |
| Notes: Source: TRICARE Management Activity Uniform Business Office User’s Guide [1/1/2005: new; 7/1/2006: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104989763 | 19th Mdss Sgsr | Military/U.S. Coast Guard Pharmacy | 1090 Arnold Dr Bldg 1090, Little Rock Afb, AR 72099-4933 | 2006-12-18 |
| 1932208972 | 19th Mdss Sgsr | Military/U.S. Coast Guard Pharmacy | 1090 Arnold Dr, Little Rock Afb, AR 72099-4933 | 2006-09-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023117066 | Reynolds Army Community Hospital | Military/U.S. Coast Guard Pharmacy | 10020 Kabrich Cir, Pine Bluff, AR 71602-9031 | 2006-09-22 |
| 1073591830 | 19th Mdss Sgsr | Military/U.S. Coast Guard Pharmacy | 1090 Arnold Dr, Lr Afb, AR 72099-4933 | 2006-01-03 |
| City | LITTLE ROCK AFB |
| Zip Code | 72099 |
Please comment or provide details below to improve the information on 19TH MDSS SGSR.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.