Provider Demographics
NPI:1043984156
Name:SULZMAN, GRACE
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:SULZMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 W PAULINE WHITAKER PKWY
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-9104
Mailing Address - Country:US
Mailing Address - Phone:479-254-6806
Mailing Address - Fax:
Practice Address - Street 1:5000 W PAULINE WHITAKER PKWY
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-9104
Practice Address - Country:US
Practice Address - Phone:479-254-6806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD15845183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist