Provider Demographics
NPI:1831578731
Name:BAIR, JOHN BERNARD II (PD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:BERNARD
Last Name:BAIR
Suffix:II
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 1:6 PALMETTO CT
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-5537
Mailing Address - Country:US
Mailing Address - Phone:501-529-9231
Mailing Address - Fax:
Practice Address - Street 1:19301 CANTRELL RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-4457
Practice Address - Country:US
Practice Address - Phone:501-868-9854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD08963183500000X
OK12334183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist