Provider Demographics
NPI:1588203509
Name:CULPEPPER, CHARLES BRIAN (PD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:BRIAN
Last Name:CULPEPPER
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 BURROUGHS ST
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-4860
Mailing Address - Country:US
Mailing Address - Phone:501-624-6033
Mailing Address - Fax:
Practice Address - Street 1:4407 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-7253
Practice Address - Country:US
Practice Address - Phone:501-525-7341
Practice Address - Fax:501-525-6928
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD07131183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPD07131OtherARKANSAS PHARMACIST LICENSE