Provider Demographics
NPI:1275947616
Name:EUBANKS, TIMOTHY (PHARMD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:EUBANKS
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 1:20381 ARCH ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206-9218
Mailing Address - Country:US
Mailing Address - Phone:501-888-2830
Mailing Address - Fax:501-888-3118
Practice Address - Street 1:20381 ARCH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72206-9218
Practice Address - Country:US
Practice Address - Phone:501-888-2830
Practice Address - Fax:501-888-3118
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD12712183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist