MEDICARE: CAUL CORBELL 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	PD12616	AR

General Provider Information

NPI Number	:	1902201288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAUL CORBELL PHARM.D

Provider Business Mailing Address
First Line	:	100 W DICKSON ST
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72701-5219
Country	:	US
Telephone Number	:	479-442-6262
Fax Number	:	479-587-0889

Provider Business Practice Location Address
First Line	:	100 W DICKSON ST
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72701-5219
Country	:	US
Telephone Number	:	479-442-6262
Fax Number	:	479-587-0889

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

Provider Enumeration Date	:	10/28/2014
Last Update Date	:	10/28/2014

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Directions to “ CAUL CORBELL PHARM.D” Practice Location

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