Provider Demographics
NPI:1023763513
Name:BREEZEEL, JUSTIN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:BREEZEEL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6307 RIDGECREST DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-2926
Mailing Address - Country:US
Mailing Address - Phone:979-308-6949
Mailing Address - Fax:
Practice Address - Street 1:2307 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-1800
Practice Address - Country:US
Practice Address - Phone:870-581-9029
Practice Address - Fax:870-581-3408
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD11950183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist