Provider Demographics
NPI:1013013135
Name:FUTRELL, JEFFREY MARK (PD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MARK
Last Name:FUTRELL
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-3402
Mailing Address - Country:US
Mailing Address - Phone:870-892-5615
Mailing Address - Fax:870-892-2592
Practice Address - Street 1:115 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-3402
Practice Address - Country:US
Practice Address - Phone:870-892-5615
Practice Address - Fax:870-892-2592
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist