Provider Demographics
NPI:1790032175
Name:PRICE, JEFFERY L (PHARMD)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:L
Last Name:PRICE
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 1:2 FOREST PARK DR STE A
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY ISLAND
Mailing Address - State:AR
Mailing Address - Zip Code:72631-9229
Mailing Address - Country:US
Mailing Address - Phone:479-239-2121
Mailing Address - Fax:479-239-2122
Practice Address - Street 1:2 FOREST PARK DR STE A
Practice Address - Street 2:
Practice Address - City:HOLIDAY ISLAND
Practice Address - State:AR
Practice Address - Zip Code:72631-9229
Practice Address - Country:US
Practice Address - Phone:479-239-2121
Practice Address - Fax:479-239-2122
Is Sole Proprietor?:No
Enumeration Date:2012-08-05
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD08764183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist