MEDICARE: MARK A WEAR PHARM 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	08795	AR

General Provider Information

NPI Number	:	1487921771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK A WEAR PHARM D.

Provider Business Mailing Address
First Line	:	9505 E POINTE DR
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-7127
Country	:	US
Telephone Number	:	479-452-1766
Fax Number	:

Provider Business Practice Location Address
First Line	:	9505 E POINTE DR
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-7127
Country	:	US
Telephone Number	:	479-452-1766
Fax Number	:

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

Provider Enumeration Date	:	11/30/2011
Last Update Date	:	11/30/2011

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