Healthcare Provider Details

I. General information

NPI: 1962324962
Provider Name (Legal Business Name): REID DEAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 S RIFE MEDICAL LN
ROGERS AR
72758-1452
US

IV. Provider business mailing address

3579 W COUNTRY MEADOWS ST
FAYETTEVILLE AR
72704-5018
US

V. Phone/Fax

Practice location:
  • Phone: 479-338-2674
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD17811
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: