Provider Demographics
NPI:1699050872
Name:PHELAN, TIMOTHY R (RPH)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:R
Last Name:PHELAN
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 1:131 N 26 ST
Mailing Address - Street 2:WALGREENS 10715
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923
Mailing Address - Country:US
Mailing Address - Phone:870-230-1809
Mailing Address - Fax:870-230-1841
Practice Address - Street 1:131 N 26 ST
Practice Address - Street 2:WALGREENS
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923
Practice Address - Country:US
Practice Address - Phone:870-230-1809
Practice Address - Fax:870-230-1841
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD06379183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist