Provider Demographics
NPI:1316050495
Name:VINSON, JOHN ALAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALAN
Last Name:VINSON
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 1:7403 WORTH AVE E
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-6886
Mailing Address - Country:US
Mailing Address - Phone:479-462-9640
Mailing Address - Fax:
Practice Address - Street 1:417 S VICTORY ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201-2932
Practice Address - Country:US
Practice Address - Phone:501-372-5250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR09847183500000X
ARPD09847183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR09847OtherPHARMACIST LICENSE NUMBER