Provider Demographics
NPI:1538443551
Name:CALDWELL, MAX A
Entity type:Individual
Prefix:
First Name:MAX
Middle Name:A
Last Name:CALDWELL
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 1:2005 AIRPARK RD
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-1806
Mailing Address - Country:US
Mailing Address - Phone:870-238-7085
Mailing Address - Fax:870-238-8937
Practice Address - Street 1:804 FALLS BLVD S
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-3505
Practice Address - Country:US
Practice Address - Phone:870-238-7085
Practice Address - Fax:870-238-8937
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD06866183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist