Healthcare Provider Details

I. General information

NPI: 1790418978
Provider Name (Legal Business Name): KHRISTAN URAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W EMMA AVE
SPRINGDALE AR
72764-4471
US

IV. Provider business mailing address

400 W EMMA AVE
SPRINGDALE AR
72764-4471
US

V. Phone/Fax

Practice location:
  • Phone: 479-750-2220
  • Fax:
Mailing address:
  • Phone: 479-750-2220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD16223
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: