Provider Demographics
NPI:1851434179
Name:FANCHER, GARY (RPH)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:FANCHER
Suffix:
Gender:M
Credentials:RPH
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 519
Mailing Address - Street 2:
Mailing Address - City:FLIPPIN
Mailing Address - State:AR
Mailing Address - Zip Code:72634-0519
Mailing Address - Country:US
Mailing Address - Phone:870-453-2218
Mailing Address - Fax:870-453-2280
Practice Address - Street 1:JUNCTION HWY 62 412 AND 178
Practice Address - Street 2:
Practice Address - City:FLIPPIN
Practice Address - State:AR
Practice Address - Zip Code:72634-0519
Practice Address - Country:US
Practice Address - Phone:870-453-2218
Practice Address - Fax:870-453-2280
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR6150183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist