Healthcare Provider Details

I. General information

NPI: 1528055910
Provider Name (Legal Business Name): THOMAS L WARMACK PD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 W 4TH ST
FORDYCE AR
71742-2216
US

IV. Provider business mailing address

613 GARY LN
SHERIDAN AR
72150-7049
US

V. Phone/Fax

Practice location:
  • Phone: 870-352-2161
  • Fax: 870-352-3236
Mailing address:
  • Phone: 870-942-3835
  • Fax: 870-352-3236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5281
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: