MEDICARE: JENNIFER MAINALI

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
1	183500000X	Pharmacist	PD11672	AR

General Provider Information

NPI Number	:	1841890605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MAINALI

Provider Business Mailing Address
First Line	:	303 BURNTWOOD ST
Second Line	:
City	:	SHERWOOD
State	:	AR
Zip	:	72120-5514
Country	:	US
Telephone Number	:	501-206-1895
Fax Number	:

Provider Business Practice Location Address
First Line	:	5600 LANDERS RD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72117-1903
Country	:	US
Telephone Number	:	501-955-9451
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2020
Last Update Date	:	10/29/2020

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Directions to “ JENNIFER MAINALI ” Practice Location

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