Healthcare Provider Details

I. General information

NPI: 1467377127
Provider Name (Legal Business Name): COLBY CORMELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 DAVE WARD DR STE 108
CONWAY AR
72034-7040
US

IV. Provider business mailing address

3290A LILLIAN CV
CONWAY AR
72034-7290
US

V. Phone/Fax

Practice location:
  • Phone: 501-450-0000
  • Fax: 501-450-6433
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD17789
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: