Healthcare Provider Details

I. General information

NPI: 1437073012
Provider Name (Legal Business Name): JARED RUSSELL RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14000 CANTRELL RD
LITTLE ROCK AR
72223-1510
US

IV. Provider business mailing address

14000 CANTRELL RD
LITTLE ROCK AR
72223-1517
US

V. Phone/Fax

Practice location:
  • Phone: 501-225-6006
  • Fax: 501-225-3926
Mailing address:
  • Phone: 501-225-6006
  • Fax: 501-225-3926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPD17850
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: