Provider Demographics
NPI:1982643409
Name:DUNN, JEFFERY FENTON SR (RPH PD)
Entity Type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:FENTON
Last Name:DUNN
Suffix:SR
Gender:M
Credentials:RPH PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 348
Mailing Address - Street 2:111 E PEDDICORD STREET
Mailing Address - City:DERMOTT
Mailing Address - State:AR
Mailing Address - Zip Code:71638
Mailing Address - Country:US
Mailing Address - Phone:870-538-5510
Mailing Address - Fax:870-538-5717
Practice Address - Street 1:111 E PEDDICORD STREET
Practice Address - Street 2:
Practice Address - City:DERMOTT
Practice Address - State:AR
Practice Address - Zip Code:71638
Practice Address - Country:US
Practice Address - Phone:870-538-5510
Practice Address - Fax:870-538-5717
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR05303183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0412990Medicare UPIN