Provider Demographics
NPI:1417942475
Name:KORKAMES, JOSEPH A (PD)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:A
Last Name:KORKAMES
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 MASSARD RD
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-6624
Mailing Address - Country:US
Mailing Address - Phone:479-478-9256
Mailing Address - Fax:
Practice Address - Street 1:6802 ROGERS AVE
Practice Address - Street 2:#2
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4068
Practice Address - Country:US
Practice Address - Phone:479-452-6116
Practice Address - Fax:479-484-7409
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR6370183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist