Provider Demographics
NPI:1043628076
Name:WEST, DEBORAH (PD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:WEST
Suffix:
Gender:F
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1328 REDWOLF BLVD.
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-5940
Mailing Address - Country:US
Mailing Address - Phone:870-802-3749
Mailing Address - Fax:
Practice Address - Street 1:1328 RED WOLF BLVD.
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5940
Practice Address - Country:US
Practice Address - Phone:870-802-3749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR07739183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist