Provider Demographics
NPI:1114608619
Name:MAULDIN, DEREK (PHARMD)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:MAULDIN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CARNATION PL
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-9012
Mailing Address - Country:US
Mailing Address - Phone:501-545-9857
Mailing Address - Fax:
Practice Address - Street 1:4407 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-7253
Practice Address - Country:US
Practice Address - Phone:501-525-7296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD16671183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist