Provider Demographics
NPI:1649838335
Name:AUSTIN, JAMES HAROLD
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:HAROLD
Last Name:AUSTIN
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 1:118 MAIN ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAVETTE
Mailing Address - State:AR
Mailing Address - Zip Code:72736-8719
Mailing Address - Country:US
Mailing Address - Phone:479-787-5432
Mailing Address - Fax:479-787-5851
Practice Address - Street 1:118 MAIN ST NE
Practice Address - Street 2:
Practice Address - City:GRAVETTE
Practice Address - State:AR
Practice Address - Zip Code:72736-8719
Practice Address - Country:US
Practice Address - Phone:479-787-5432
Practice Address - Fax:479-787-5851
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD13734183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist