Healthcare Provider Details

I. General information

NPI: 1013247436
Provider Name (Legal Business Name): DIBRELL WADE WILLIAMS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2010
Last Update Date: 01/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 E RACE AVE
SEARCY AR
72143-4662
US

IV. Provider business mailing address

1540 E RACE AVE
SEARCY AR
72143-4662
US

V. Phone/Fax

Practice location:
  • Phone: 501-268-5315
  • Fax: 501-279-7782
Mailing address:
  • Phone: 501-268-5315
  • Fax: 501-279-7782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD09167
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: