Provider Demographics
NPI:1821313305
Name:BOYD, PHILLIP JUSTIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:JUSTIN
Last Name:BOYD
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:PO BOX 2550
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:AR
Mailing Address - Zip Code:72921-2550
Mailing Address - Country:US
Mailing Address - Phone:479-632-2248
Mailing Address - Fax:479-632-2386
Practice Address - Street 1:18 HWY 162 SOUTH
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:AR
Practice Address - Zip Code:72921
Practice Address - Country:US
Practice Address - Phone:479-632-2248
Practice Address - Fax:479-632-2386
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD9128183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPD9128OtherLICENSE