Provider Demographics
NPI:1174123616
Name:HUNGERFORD, JAY RYAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:RYAN
Last Name:HUNGERFORD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:JAY
Other - Middle Name:RYAN
Other - Last Name:HUNGERFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:304 SW DUKE AVE
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3683
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2110 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3246
Practice Address - Country:US
Practice Address - Phone:479-636-8238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD12732183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist