Healthcare Provider Details

I. General information

NPI: 1982204046
Provider Name (Legal Business Name): MR. MARK MARAK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2020
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8801 HIGHWAY 107
SHERWOOD AR
72120-2929
US

IV. Provider business mailing address

8801 HIGHWAY 107
SHERWOOD AR
72120-2929
US

V. Phone/Fax

Practice location:
  • Phone: 501-833-3116
  • Fax: 501-833-3122
Mailing address:
  • Phone: 501-833-3116
  • Fax: 501-833-3122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD8640
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: