Healthcare Provider Details

I. General information

NPI: 1184625402
Provider Name (Legal Business Name): RICHARD EUGENE BOECKMANN P.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 FALLS BLVD S
WYNNE AR
72396-3501
US

IV. Provider business mailing address

411 FALLS BLVD S
WYNNE AR
72396-3501
US

V. Phone/Fax

Practice location:
  • Phone: 870-238-8511
  • Fax: 870-238-2135
Mailing address:
  • Phone: 870-238-8511
  • Fax: 870-238-2135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6609
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: