Millard Formby III
Individual provider Active NPI Pharmacist · Texarkana, AR
NPI 1982469847 · NPPES record last updated Feb 19, 2024
Key facts
- NPI
- 1982469847
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- PD08043 (AR)
- Practice address
- 3710 N State Line Ave
Texarkana, AR 71854-1934 - Phone
- (870) 773-5521
- NPI assigned
- Feb 19, 2024
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
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 |
|---|---|---|---|
| PD08043 | AR | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Albertsons LLC | Past |
Accepting new patients | |
| Albertsons LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PD08043 | AR | Yes |
Addresses
Primary practice location
3710 N State Line Ave
Texarkana, AR 71854-1934
Mailing address
206 Georgian Ter
Texarkana, AR 71854-3010
Phone (903) 276-1262
Other providers in Texarkana, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 19, 2024. 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.