Provider Demographics
NPI:1043983406
Name:HUMPHREY, GASHEN (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:GASHEN
Middle Name:
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 E 38TH ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206-3654
Mailing Address - Country:US
Mailing Address - Phone:501-436-9784
Mailing Address - Fax:
Practice Address - Street 1:1914 E 38TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72206-3654
Practice Address - Country:US
Practice Address - Phone:501-436-9784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD14199183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPD14199OtherARKANSAS STATE BOARD OF PHARMACY LICENSE