Provider Demographics
NPI:1215949128
Name:SCRIBNER, MICHAEL D (PD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:SCRIBNER
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 1:5305 WHISPERING MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8812
Mailing Address - Country:US
Mailing Address - Phone:479-631-9881
Mailing Address - Fax:
Practice Address - Street 1:3380 N FUTRALL DR
Practice Address - Street 2:SUITE #2
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4057
Practice Address - Country:US
Practice Address - Phone:479-443-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7412183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist