Healthcare Provider Details

I. General information

NPI: 1720429509
Provider Name (Legal Business Name): DOUGLAS WRIGHT PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2013
Last Update Date: 02/19/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11167 SR 27
HECTOR AR
72843
US

IV. Provider business mailing address

3202 W MAIN ST
RUSSELLVILLE AR
72801-2302
US

V. Phone/Fax

Practice location:
  • Phone: 479-284-2011
  • Fax: 479-284-2032
Mailing address:
  • Phone: 479-880-0181
  • Fax: 479-880-0187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD09672
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: