Individual
JACOB MATLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2425 S ZERO ST, FORT SMITH, AR 72901-8663
(479) 646-4983
Mailing address
479745 E 1100 RD, ROLAND, OK 74954-5069
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PD11121
AR
Other
Enumeration date
11/06/2020
Last updated
11/06/2020
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