Provider Demographics
NPI:1184066490
Name:MTHONGANA, BHEKIMPILO (PHARMD)
Entity type:Individual
Prefix:
First Name:BHEKIMPILO
Middle Name:
Last Name:MTHONGANA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 E COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-7005
Mailing Address - Country:US
Mailing Address - Phone:501-388-4040
Mailing Address - Fax:
Practice Address - Street 1:12410 CANTRELL RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-1702
Practice Address - Country:US
Practice Address - Phone:501-219-1881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-28
Last Update Date:2013-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD12410183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist