Provider Demographics
NPI:1396346011
Name:PARHAM, MITCHELL SCOTT
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:SCOTT
Last Name:PARHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WAL MART PHARMACY 1601 ALBERT PIKE
Mailing Address - Street 2:1601 ALBERT PIKE
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913
Mailing Address - Country:US
Mailing Address - Phone:501-624-0142
Mailing Address - Fax:
Practice Address - Street 1:9003 MILAN AVE
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019-8777
Practice Address - Country:US
Practice Address - Phone:870-329-6557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD09367183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist