Provider Demographics
NPI:1356941124
Name:WRIGHT, LINDA CHILDERS
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:CHILDERS
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7192 S STATE HIGHWAY 308
Mailing Address - Street 2:
Mailing Address - City:TYRONZA
Mailing Address - State:AR
Mailing Address - Zip Code:72386-2204
Mailing Address - Country:US
Mailing Address - Phone:870-761-3127
Mailing Address - Fax:
Practice Address - Street 1:2720 W KEISER AVE
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:AR
Practice Address - Zip Code:72370-3443
Practice Address - Country:US
Practice Address - Phone:870-563-6633
Practice Address - Fax:870-563-8185
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD07044183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist