Provider Demographics
NPI:1679382436
Name:BURGESS, JAMES DAL (PHARMACIST)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:DAL
Last Name:BURGESS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-6036
Mailing Address - Country:US
Mailing Address - Phone:870-246-5553
Mailing Address - Fax:870-246-5553
Practice Address - Street 1:150 E SIEBENMORGEN RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4000
Practice Address - Country:US
Practice Address - Phone:501-329-6851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD06414183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist