Provider Demographics
NPI:1336562917
Name:ROZELL, PHILLIP (PD)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:
Last Name:ROZELL
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 1682
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72702-1682
Mailing Address - Country:US
Mailing Address - Phone:479-443-4747
Mailing Address - Fax:479-443-2824
Practice Address - Street 1:2515 E HUNTSVILLE RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-7329
Practice Address - Country:US
Practice Address - Phone:479-443-3411
Practice Address - Fax:479-443-3412
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-02
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD06040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist