Jasen Creek, PD
Individual provider Active NPI Pharmacist · Prescott, AR
NPI 1477958155 · NPPES record last updated Oct 24, 2014
Key facts
- NPI
- 1477958155
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- PD08834 (AR)
- Practice address
- 1430 W 1St St N
Prescott, AR 71857-3339 - Phone
- (870) 887-6664
- Fax
- (870) 887-2968
- NPI assigned
- Oct 24, 2014
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PD08834 | AR | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PD08834 | AR | Yes |
Addresses
Primary practice location
1430 W 1St St N
Prescott, AR 71857-3339
Mailing address
PO Box 524
Arkadelphia, AR 71923-0524
Phone (870) 246-5553
Other providers in Prescott, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 24, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.