Provider Demographics
NPI:1508968389
Name:HAMBUCHEN, MICHAEL D SR (RPH)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:HAMBUCHEN
Suffix:SR
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 1:2331 HERMES DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-8549
Mailing Address - Country:US
Mailing Address - Phone:501-327-0225
Mailing Address - Fax:
Practice Address - Street 1:1155 MAIN ST
Practice Address - Street 2:
Practice Address - City:VILONIA
Practice Address - State:AR
Practice Address - Zip Code:72173-9525
Practice Address - Country:US
Practice Address - Phone:501-796-2116
Practice Address - Fax:501-796-2117
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR10249183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR100647407Medicaid
AR0679160001Medicare ID - Type Unspecified