Provider Demographics
NPI:1649566746
Name:ROZELL, PHILLIP R JR (PHARMD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:R
Last Name:ROZELL
Suffix:JR
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 1:2110 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-3246
Mailing Address - Country:US
Mailing Address - Phone:479-636-8238
Mailing Address - Fax:
Practice Address - Street 1:4208 S PLEASANT CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1345
Practice Address - Country:US
Practice Address - Phone:479-621-0629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009014959183500000X
AR9842183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist