Provider Demographics
NPI:1497097430
Name:REDDING, JERRY ALLEN (RPH)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:ALLEN
Last Name:REDDING
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206-1433
Mailing Address - Country:US
Mailing Address - Phone:501-371-9229
Mailing Address - Fax:501-374-7897
Practice Address - Street 1:1601 MAIN ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72206-1433
Practice Address - Country:US
Practice Address - Phone:501-371-9229
Practice Address - Fax:501-374-7897
Is Sole Proprietor?:No
Enumeration Date:2013-03-16
Last Update Date:2013-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD06459183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist