Basic Information
| Provider Information | |||||||||
| NPI: | 1982204046 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARAK | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 8801 HIGHWAY 107 | ||||||||
| Address2: | |||||||||
| City: | SHERWOOD | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721202929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5018333116 | ||||||||
| FaxNumber: | 5018333122 | ||||||||
| Practice Location | |||||||||
| Address1: | 8801 HIGHWAY 107 | ||||||||
| Address2: | |||||||||
| City: | SHERWOOD | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721202929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5018333116 | ||||||||
| FaxNumber: | 5018333122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2020 | ||||||||
| LastUpdateDate: | 10/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PD8640 | AR | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.