Provider Demographics
NPI:1962688531
Name:TROTTER, JAY MICHAEL (PD)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:MICHAEL
Last Name:TROTTER
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 RIVER OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4536
Mailing Address - Country:US
Mailing Address - Phone:501-305-4261
Mailing Address - Fax:
Practice Address - Street 1:409 RIVER OAKS BLVD
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4536
Practice Address - Country:US
Practice Address - Phone:501-305-4261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR06793183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist