Provider Demographics
NPI:1861107161
Name:PRICE, MARK CHRISTIAN (PHARMD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:CHRISTIAN
Last Name:PRICE
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 1:3151 HIGHWAY 35
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-6101
Mailing Address - Country:US
Mailing Address - Phone:501-231-0613
Mailing Address - Fax:
Practice Address - Street 1:13907 HIGH RD
Practice Address - Street 2:
Practice Address - City:MABELVALE
Practice Address - State:AR
Practice Address - Zip Code:72103-3212
Practice Address - Country:US
Practice Address - Phone:501-451-7715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD10482183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist