Provider Demographics
NPI:1104812312
Name:ALEXANDER, SAMUEL (R PH)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 E RUSH AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-4326
Mailing Address - Country:US
Mailing Address - Phone:870-741-8189
Mailing Address - Fax:
Practice Address - Street 1:127 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-4227
Practice Address - Country:US
Practice Address - Phone:870-741-6511
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5408183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist