Healthcare Provider Details

I. General information

NPI: 1952490385
Provider Name (Legal Business Name): CHAD WILLIAM SLEDGE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14000 CANTRELL RD
LITTLE ROCK AR
72223-1517
US

IV. Provider business mailing address

2121 WELLINGTON PLANTATION DR
LITTLE ROCK AR
72211-2152
US

V. Phone/Fax

Practice location:
  • Phone: 501-225-6006
  • Fax:
Mailing address:
  • Phone: 501-351-3167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPD10124
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD10124
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: