Healthcare Provider Details

I. General information

NPI: 1699362848
Provider Name (Legal Business Name): ANTHONY TODD HERRIMAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2020
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2507 MARKET TRCE
FORT SMITH AR
72908-8677
US

IV. Provider business mailing address

4430 W LOFTY WOOD DR
FAYETTEVILLE AR
72704-7521
US

V. Phone/Fax

Practice location:
  • Phone: 479-646-5505
  • Fax: 479-646-7353
Mailing address:
  • Phone: 479-871-2398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number09699
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: