Provider Demographics
NPI:1275129850
Name:BARRETT, DUSTYN (PHARM D)
Entity Type:Individual
Prefix:
First Name:DUSTYN
Middle Name:
Last Name:BARRETT
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREEN FOREST
Mailing Address - State:AR
Mailing Address - Zip Code:72638-2312
Mailing Address - Country:US
Mailing Address - Phone:870-438-5614
Mailing Address - Fax:870-438-6256
Practice Address - Street 1:703 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GREEN FOREST
Practice Address - State:AR
Practice Address - Zip Code:72638-2312
Practice Address - Country:US
Practice Address - Phone:870-438-5614
Practice Address - Fax:870-438-6256
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD09482183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist