Healthcare Provider Details

I. General information

NPI: 1043136351
Provider Name (Legal Business Name): BLAKE ALLEN FERRELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8511 W MARKHAM ST
LITTLE ROCK AR
72205-2432
US

IV. Provider business mailing address

1117 NATURE WAY
BENTON AR
72019-5003
US

V. Phone/Fax

Practice location:
  • Phone: 501-313-4480
  • Fax: 501-414-8946
Mailing address:
  • Phone: 501-326-2118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD17812
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: