Healthcare Provider Details

I. General information

NPI: 1104813674
Provider Name (Legal Business Name): RONALD EDGAR NORRIS P.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 HOLLY ST
MC GEHEE AR
71654-2111
US

IV. Provider business mailing address

712 HOLLY ST
MC GEHEE AR
71654-2111
US

V. Phone/Fax

Practice location:
  • Phone: 870-222-3080
  • Fax: 870-222-6561
Mailing address:
  • Phone: 870-222-3080
  • Fax: 870-222-6561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6095
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: