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General NPI Number Information
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NPI Number | 1184302606
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Entity Type | Individual
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Provider Name | JACOB A WINGFIELD PHARMD
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Gender | Male
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Dates
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Enumeration Date | 07/05/2023
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Last Update Date | 07/09/2023
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Provider Practice Location Address
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Address Line | 2110 W WALNUT ST
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City | ROGERS
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State | AR
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Zip | 72756-3246
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Country | US
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Telephone | 479-277-2483
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Fax |
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Provider Business Mailing Address
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Address Line | 4101 W HUNTINGTON DR APT 7207
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City | ROGERS
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State | AR
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Zip | 72758-1713
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Country | US
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Telephone | 501-765-1230
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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 | PD16626
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License Number State | AR
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