Provider Demographics
NPI:1255998514
Name:HERZIG, GWENDOLYN PAIGE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:GWENDOLYN
Middle Name:PAIGE
Last Name:HERZIG
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 AUTUMN RD STE 275
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3745
Mailing Address - Country:US
Mailing Address - Phone:501-224-3499
Mailing Address - Fax:501-224-1140
Practice Address - Street 1:904 AUTUMN RD STE 275
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3745
Practice Address - Country:US
Practice Address - Phone:501-224-3499
Practice Address - Fax:501-224-1140
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-22
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD14069183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist