Provider Demographics
NPI:1700501228
Name:BULTENA, LOYD BARRY (PD)
Entity Type:Individual
Prefix:MR
First Name:LOYD
Middle Name:BARRY
Last Name:BULTENA
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LANDMARK PHARMACY
Mailing Address - Street 2:3401 ATWOOD RD, SUITE E
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206
Mailing Address - Country:US
Mailing Address - Phone:501-888-2223
Mailing Address - Fax:501-888-7504
Practice Address - Street 1:LANDMARK PHARMACY
Practice Address - Street 2:3401 ATWOOD RD, SUITE E
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72206
Practice Address - Country:US
Practice Address - Phone:501-888-2223
Practice Address - Fax:501-888-7504
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD07730183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist