Provider Demographics
NPI:1396417267
Name:WHITSELL, JESTON BROCK (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JESTON
Middle Name:BROCK
Last Name:WHITSELL
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 1:606 VALLEY WEST DR
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-1768
Mailing Address - Country:US
Mailing Address - Phone:479-283-3003
Mailing Address - Fax:
Practice Address - Street 1:375 E MILLSAP RD STE 3
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-6289
Practice Address - Country:US
Practice Address - Phone:479-445-6833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD14573183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist