Healthcare Provider Details

I. General information

NPI: 1285656363
Provider Name (Legal Business Name): ALTON CHAMBLESS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1626 S MADISON ST
DEWITT AR
72042-3003
US

IV. Provider business mailing address

1109 LEE ST.
DEWITT AR
72042
US

V. Phone/Fax

Practice location:
  • Phone: 870-946-1706
  • Fax: 870-946-3024
Mailing address:
  • Phone: 870-946-1048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5560
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: