Provider Demographics
NPI:1699362848
Name:HERRIMAN, ANTHONY TODD (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:TODD
Last Name:HERRIMAN
Suffix:
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 1:4430 W LOFTY WOOD DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-7521
Mailing Address - Country:US
Mailing Address - Phone:479-871-2398
Mailing Address - Fax:
Practice Address - Street 1:2507 MARKET TRCE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72908-8677
Practice Address - Country:US
Practice Address - Phone:479-646-5505
Practice Address - Fax:479-646-7353
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR096991835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory CareGroup - Single Specialty