Provider Demographics
NPI:1417549528
Name:HUMPHRIES, JOHN DAVID (PD PHARMACIST)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:HUMPHRIES
Suffix:
Gender:M
Credentials:PD PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 E VAN BUREN
Mailing Address - Street 2:
Mailing Address - City:EUREKA SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72632-3653
Mailing Address - Country:US
Mailing Address - Phone:479-253-9175
Mailing Address - Fax:
Practice Address - Street 1:133 E VAN BUREN
Practice Address - Street 2:
Practice Address - City:EUREKA SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72632-3653
Practice Address - Country:US
Practice Address - Phone:479-253-9175
Practice Address - Fax:479-253-8460
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD07251183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist