Provider Demographics
NPI:1154923894
Name:PATTERMANN, JEFF (PD)
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:PATTERMANN
Suffix:
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:PO BOX 10116
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72812-0116
Mailing Address - Country:US
Mailing Address - Phone:479-886-1143
Mailing Address - Fax:
Practice Address - Street 1:230 E MARKET ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-9069
Practice Address - Country:US
Practice Address - Phone:479-754-6169
Practice Address - Fax:479-754-6419
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD06178183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist