Healthcare Provider Details

I. General information

NPI: 1164287702
Provider Name (Legal Business Name): MELEONY ANN OGLESBY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 S CONSTITUTION AVE
ASHDOWN AR
71822-8652
US

IV. Provider business mailing address

129 LR 129
FOREMAN AR
71836-8522
US

V. Phone/Fax

Practice location:
  • Phone: 870-898-5501
  • Fax:
Mailing address:
  • Phone: 903-276-6233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD07407
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: