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General NPI Number Information
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NPI Number | 1396346011
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Entity Type | Individual
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Provider Name | MITCHELL SCOTT PARHAM
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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 | 9003 MILAN AVE
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City | BENTON
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State | AR
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Zip | 72019-8777
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Country | US
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Telephone | 870-329-6557
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Fax |
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Provider Business Mailing Address
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Address Line | WAL MART PHARMACY 1601 ALBERT PIKE 1601 ALBERT PIKE
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City | HOT SPRINGS
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State | AR
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Zip | 71913
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Country | US
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Telephone | 501-624-0142
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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 | PD09367
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License Number State | AR
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