Provider Demographics
NPI:1972221018
Name:FAIN, MARK STEWART (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEWART
Last Name:FAIN
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 1:112 HOUSTON AVE
Mailing Address - Street 2:
Mailing Address - City:PERRYVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72126-9451
Mailing Address - Country:US
Mailing Address - Phone:501-889-5111
Mailing Address - Fax:501-889-2878
Practice Address - Street 1:112 HOUSTON AVE
Practice Address - Street 2:
Practice Address - City:PERRYVILLE
Practice Address - State:AR
Practice Address - Zip Code:72126-9451
Practice Address - Country:US
Practice Address - Phone:501-889-5111
Practice Address - Fax:501-889-2878
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD14305183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist