Provider Demographics
NPI:1578616546
Name:ESAU, PATRICIA FAYE (PD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:FAYE
Last Name:ESAU
Suffix:
Gender:F
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-4637
Mailing Address - Country:US
Mailing Address - Phone:870-743-6971
Mailing Address - Fax:
Practice Address - Street 1:620 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601
Practice Address - Country:US
Practice Address - Phone:870-414-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-20
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7558183500000X
OK8997183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist