Healthcare Provider Details

I. General information

NPI: 1720138068
Provider Name (Legal Business Name): CLIFFORD MARSH DAVIS PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 62-412 MIDWAY PLAZA
HARDY AR
72542
US

IV. Provider business mailing address

PO BOX 428
ASH FLAT AR
72513-0428
US

V. Phone/Fax

Practice location:
  • Phone: 970-856-3080
  • Fax: 870-856-4165
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberAR8368
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: