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General NPI Number Information
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NPI Number | 1154923894
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Entity Type | Individual
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Provider Name | JEFF PATTERMANN PD
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Gender | Male
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Dates
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Enumeration Date | 11/09/2020
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Last Update Date | 11/09/2020
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Provider Practice Location Address
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Address Line | 230 E MARKET ST
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City | CLARKSVILLE
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State | AR
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Zip | 72830-9069
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Country | US
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Telephone | 479-754-6169
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Fax | 479-754-6419
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Provider Business Mailing Address
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Address Line | PO BOX 10116
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City | RUSSELLVILLE
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State | AR
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Zip | 72812-0116
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Country | US
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Telephone | 479-886-1143
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PD06178
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License Number State | AR
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