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NPI Code Detail

MEDICARE: MRS. REBECCA ANN RENICK DOCTOR OF PHARMACY

MEDICARE: MRS. REBECCA ANN RENICK DOCTOR OF PHARMACY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistPD09688AR

General Provider Information

NPI Number : 1003403718
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. REBECCA ANN RENICK DOCTOR OF PHARMACY
Provider Business Mailing Address
First Line : 9097 STONE CANYON DR
Second Line :
City : ALEXANDER
State : AR
Zip : 72002-5012
Country : US
Telephone Number : 501-580-1909
Fax Number :
Provider Business Practice Location Address
First Line : 4307 E BROADWAY ST
Second Line :
City : NORTH LITTLE ROCK
State : AR
Zip : 72117-4124
Country : US
Telephone Number : 501-945-3264
Fax Number : 501-945-6976
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2020
Last Update Date : 12/29/2020

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