Provider Demographics
NPI:1548256688
Name:POWELL, JOHN LEE II (PD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LEE
Last Name:POWELL
Suffix:II
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 HIGHWAY 65 S
Mailing Address - Street 2:
Mailing Address - City:MC GEHEE
Mailing Address - State:AR
Mailing Address - Zip Code:71654-9417
Mailing Address - Country:US
Mailing Address - Phone:870-222-6676
Mailing Address - Fax:870-222-6679
Practice Address - Street 1:1007 HIGHWAY 65 S
Practice Address - Street 2:
Practice Address - City:MC GEHEE
Practice Address - State:AR
Practice Address - Zip Code:71654-9417
Practice Address - Country:US
Practice Address - Phone:870-222-6676
Practice Address - Fax:870-222-6679
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR6650183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0417635OtherNABP
AR0417635OtherNABP
AR1227660001Medicare ID - Type Unspecified