Provider Demographics
NPI:1144633132
Name:EZELL, DUSTIN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:
Last Name:EZELL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6044 ALLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:N LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-3706
Mailing Address - Country:US
Mailing Address - Phone:501-765-1776
Mailing Address - Fax:501-945-6976
Practice Address - Street 1:2609 MCCAIN BLVD
Practice Address - Street 2:
Practice Address - City:N LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-8013
Practice Address - Country:US
Practice Address - Phone:501-353-1984
Practice Address - Fax:501-353-2698
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD12618183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPD12618OtherARKANSAS PHARMACISTS LICENSE