Provider Demographics
NPI:1497476204
Name:DAUGHERTY, JAMES MACKENZIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MACKENZIE
Last Name:DAUGHERTY
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 1:1202 E 21ST ST
Mailing Address - Street 2:
Mailing Address - City:STUTTGART
Mailing Address - State:AR
Mailing Address - Zip Code:72160-6910
Mailing Address - Country:US
Mailing Address - Phone:870-830-8565
Mailing Address - Fax:
Practice Address - Street 1:220 COURT SQ
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:AR
Practice Address - Zip Code:72042-2057
Practice Address - Country:US
Practice Address - Phone:870-946-4211
Practice Address - Fax:870-946-1011
Is Sole Proprietor?:No
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD16216183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist