Healthcare Provider Details

I. General information

NPI: 1235755885
Provider Name (Legal Business Name): LISA MICHELLE BUELL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2020
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 SALEM RD
BENTON AR
72019-8340
US

IV. Provider business mailing address

19 OLD FORGE CT
LITTLE ROCK AR
72227-3857
US

V. Phone/Fax

Practice location:
  • Phone: 15-316-1600
  • Fax: 501-316-1700
Mailing address:
  • Phone: 870-509-1524
  • Fax: 501-358-6593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD12740
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: