Provider Demographics
NPI:1205104346
Name:VINCENT, JOE W (PHARMACIST)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:W
Last Name:VINCENT
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 FLEMING AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4311
Mailing Address - Country:US
Mailing Address - Phone:870-933-5216
Mailing Address - Fax:
Practice Address - Street 1:1201 FLEMING AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4311
Practice Address - Country:US
Practice Address - Phone:870-933-5216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-04
Last Update Date:2011-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD06250183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist