MEDICARE: MR. JOSEPH A KORKAMES P.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	6370	AR

General Provider Information

NPI Number	:	1417942475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH A KORKAMES P.D.

Provider Business Mailing Address
First Line	:	5301 MASSARD RD
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-6624
Country	:	US
Telephone Number	:	479-478-9256
Fax Number	:

Provider Business Practice Location Address
First Line	:	6802 ROGERS AVE
Second Line	:	#2
City	:	FORT SMITH
State	:	AR
Zip	:	72903-4068
Country	:	US
Telephone Number	:	479-452-6116
Fax Number	:	479-484-7409

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	07/08/2007

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