Provider Demographics
NPI:1427471010
Name:LESSENBERRY, GUY WILSON (PD)
Entity type:Individual
Prefix:
First Name:GUY
Middle Name:WILSON
Last Name:LESSENBERRY
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 1:1050 COUNTY ROAD 310
Mailing Address - Street 2:
Mailing Address - City:BERRYVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72616-9454
Mailing Address - Country:US
Mailing Address - Phone:870-480-8972
Mailing Address - Fax:
Practice Address - Street 1:1006 W TRIMBLE AVE
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:AR
Practice Address - Zip Code:72616-4618
Practice Address - Country:US
Practice Address - Phone:870-423-2094
Practice Address - Fax:870-423-4302
Is Sole Proprietor?:No
Enumeration Date:2014-02-02
Last Update Date:2014-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD5810183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist