Provider Demographics
NPI:1588260756
Name:ORLICEK, GREG (RPH)
Entity type:Individual
Prefix:MR
First Name:GREG
Middle Name:
Last Name:ORLICEK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-2547
Mailing Address - Country:US
Mailing Address - Phone:501-843-3374
Mailing Address - Fax:501-843-8625
Practice Address - Street 1:801 N 2ND ST
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-2547
Practice Address - Country:US
Practice Address - Phone:501-843-3374
Practice Address - Fax:501-843-8625
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD07598183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist