Healthcare Provider Details

I. General information

NPI: 1669755872
Provider Name (Legal Business Name): SAMUEL BLAKE HUTCHINS PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 W MAIN ST
HEBER SPRINGS AR
72543-3017
US

IV. Provider business mailing address

408 W MAIN ST
HEBER SPRINGS AR
72543-3017
US

V. Phone/Fax

Practice location:
  • Phone: 501-270-8888
  • Fax: 501-270-6677
Mailing address:
  • Phone: 501-270-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD10374
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: