Provider Demographics
NPI:1982122818
Name:SUFYAN, ABU
Entity Type:Individual
Prefix:
First Name:ABU
Middle Name:
Last Name:SUFYAN
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 1:323 HIGHWAY 64 E
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:AR
Mailing Address - Zip Code:72921-3318
Mailing Address - Country:US
Mailing Address - Phone:479-632-9080
Mailing Address - Fax:479-632-9086
Practice Address - Street 1:323 HIGHWAY 64 E
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:AR
Practice Address - Zip Code:72921-3318
Practice Address - Country:US
Practice Address - Phone:479-632-9080
Practice Address - Fax:479-632-9086
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPI22520183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist