Individual
WAYLON ELLIOTT BULLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARM D
Contact information
Practice address
1500 W KINGSHIGHWAY, PARAGOULD, AR 72450-4009
(870) 240-8053
Mailing address
1500 W KINGSHIGHWAY, PARAGOULD, AR 72450-4009
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PD8207
AR
Other
Enumeration date
10/24/2011
Last updated
10/24/2011
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