MEDICARE: DR. JOHN ALAN VINSON PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	09847	AR
2	183500000X	Pharmacist	PD09847	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	09847	OTHER	AR	PHARMACIST LICENSE NUMBER

General Provider Information

NPI Number	:	1316050495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ALAN VINSON PHARM.D.

Provider Business Mailing Address
First Line	:	7403 WORTH AVE E
Second Line	:
City	:	BENTON
State	:	AR
Zip	:	72019-6886
Country	:	US
Telephone Number	:	479-462-9640
Fax Number	:

Provider Business Practice Location Address
First Line	:	417 S VICTORY ST
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72201-2932
Country	:	US
Telephone Number	:	501-372-5250
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	09/09/2022

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