Provider Demographics
NPI:1982204046
Name:MARAK, MARK
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:MARAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8801 HIGHWAY 107
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-2929
Mailing Address - Country:US
Mailing Address - Phone:501-833-3116
Mailing Address - Fax:501-833-3122
Practice Address - Street 1:8801 HIGHWAY 107
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-2929
Practice Address - Country:US
Practice Address - Phone:501-833-3116
Practice Address - Fax:501-833-3122
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD8640183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist