Provider Demographics
NPI:1710038930
Name:WORKMAN, WENDELL J II (PD)
Entity type:Individual
Prefix:MR
First Name:WENDELL
Middle Name:J
Last Name:WORKMAN
Suffix:II
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:213 BAFANRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-8157
Mailing Address - Country:US
Mailing Address - Phone:501-623-2009
Mailing Address - Fax:501-624-0121
Practice Address - Street 1:1534 MALVERN AVE STE B
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-6503
Practice Address - Country:US
Practice Address - Phone:501-623-2280
Practice Address - Fax:501-624-0121
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD06464183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist