Basic Information
| Provider Information | |||||||||
| NPI: | 1295945848 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WRIGHT | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | PD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 139 STONEBROOK | ||||||||
| Address2: | |||||||||
| City: | HELENA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703386464 | ||||||||
| FaxNumber: | 8703388407 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 PERRY ST | ||||||||
| Address2: | |||||||||
| City: | HELENA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723423325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703386464 | ||||||||
| FaxNumber: | 8703388407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2007 | ||||||||
| LastUpdateDate: | 09/16/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 5340 | AR | Y | Pharmacy Service Providers | Pharmacist |
ID Information
| ID | Type | State | Issuer | Description | 100272407 | 05 | AR | MEDICAID |