Provider Demographics
NPI:1558026369
Name:LIMSON, KOPONG T (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KOPONG
Middle Name:T
Last Name:LIMSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:KOPONG
Other - Middle Name:
Other - Last Name:LIMPICHAREON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6501 SW MALLET RD APT 304
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72713-8219
Mailing Address - Country:US
Mailing Address - Phone:773-988-8019
Mailing Address - Fax:
Practice Address - Street 1:4206 W NEW HOPE RD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8258
Practice Address - Country:US
Practice Address - Phone:479-621-0958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD12004183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist