Healthcare Provider Details

I. General information

NPI: 1972103521
Provider Name (Legal Business Name): DR. ERIC ESCUE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2020
Last Update Date: 10/31/2020
Certification Date: 10/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 E HIGHLAND DR
JONESBORO AR
72401-6118
US

IV. Provider business mailing address

1815 E HIGHLAND DR
JONESBORO AR
72401-6118
US

V. Phone/Fax

Practice location:
  • Phone: 870-972-1838
  • Fax:
Mailing address:
  • Phone: 870-972-1838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD13695
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: