Healthcare Provider Details

I. General information

NPI: 1871440974
Provider Name (Legal Business Name): ETHAN PELL PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 HWY 25B
HEBER SPGS AR
72543
US

IV. Provider business mailing address

1110 JANICE DR
CABOT AR
72023-3039
US

V. Phone/Fax

Practice location:
  • Phone: 501-362-5837
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD17672
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: