Provider Demographics
NPI:1083041693
Name:DALLAS, BARRY JOE (PD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:JOE
Last Name:DALLAS
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 1:10 EAGLE ST
Mailing Address - Street 2:
Mailing Address - City:VILONIA
Mailing Address - State:AR
Mailing Address - Zip Code:72173-9214
Mailing Address - Country:US
Mailing Address - Phone:501-796-2816
Mailing Address - Fax:501-796-2819
Practice Address - Street 1:10 EAGLE ST
Practice Address - Street 2:
Practice Address - City:VILONIA
Practice Address - State:AR
Practice Address - Zip Code:72173-9214
Practice Address - Country:US
Practice Address - Phone:501-796-2816
Practice Address - Fax:501-796-2819
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD06142183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR183500000XOtherTAXONOMY CODE FOR PHARMACIST