Provider Demographics
NPI:1457999518
Name:PHIFER, JOSHUA B (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:B
Last Name:PHIFER
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 1:1003 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-3517
Mailing Address - Country:US
Mailing Address - Phone:479-890-3402
Mailing Address - Fax:479-890-3407
Practice Address - Street 1:1003 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-3517
Practice Address - Country:US
Practice Address - Phone:479-890-3402
Practice Address - Fax:479-890-3407
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-19
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD13068183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPD13068OtherARKANSAS PHARMACIST LICENSE