Provider Demographics
NPI:1548342033
Name:JEFFREY, MICHAEL L
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:JEFFREY
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:L
Other - Last Name:JEFFREY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 316
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:AR
Mailing Address - Zip Code:72562-0316
Mailing Address - Country:US
Mailing Address - Phone:870-799-3901
Mailing Address - Fax:
Practice Address - Street 1:503 VINE ST.
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:AR
Practice Address - Zip Code:72562-0316
Practice Address - Country:US
Practice Address - Phone:870-799-3411
Practice Address - Fax:870-799-8439
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD06065183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist