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1861097081 NPI number — OLLIE DWAYNE LUNBECK

NPI Number: 1861097081
Health Care Provider/Practitioner: OLLIE DWAYNE LUNBECK

Information about “1861097081” NPI (OLLIE DWAYNE LUNBECK) exists in 1861097081 in HTML format HTML  |  1861097081 in plain Text format TXT  |  1861097081 in PDF (Portable Document Format) PDF  |  1861097081 in an XML format XML  formats.

NPI Number : 1861097081 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1861097081",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LUNBECK",
    "FirstName": "OLLIE",
    "MiddleName": "DWAYNE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1720 GRACE PL",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BENTONVILLE",
    "MailingAddressStateName": "AR",
    "MailingAddressPostalCode": "72713-3070",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "870-930-6903",
    "MailingAddressFaxNumber": "479-251-1947",
    "FirstLinePracticeLocationAddress": "2402 N COLLEGE AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FAYETTEVILLE",
    "PracticeLocationAddressStateName": "AR",
    "PracticeLocationAddressPostalCode": "72703-3308",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "479-251-1872",
    "PracticeLocationAddressFaxNumber": "479-251-1947",
    "EnumerationDate": "12/04/2020",
    "LastUpdateDate": "12/04/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "183500000X",
        "TaxonomyName": "Pharmacist",
        "LicenseNumber": "PD08303",
        "LicenseNumberStateCode": "AR",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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