Provider Demographics
NPI:1013329663
Name:ERWIN, RICHARD (PD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:ERWIN
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 1:1920 ROYAL DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-7346
Mailing Address - Country:US
Mailing Address - Phone:501-223-2262
Mailing Address - Fax:501-223-0648
Practice Address - Street 1:9112 N RODNEY PARHAM RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-1648
Practice Address - Country:US
Practice Address - Phone:501-223-2262
Practice Address - Fax:501-223-0648
Is Sole Proprietor?:No
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD06621183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist