Healthcare Provider Details

I. General information

NPI: 1801488226
Provider Name (Legal Business Name): KATY DENISE BOSTIC PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1286 HIGHWAY 278 BYP
CAMDEN AR
71701-4552
US

IV. Provider business mailing address

1286 HIGHWAY 278 BYP
CAMDEN AR
71701-4552
US

V. Phone/Fax

Practice location:
  • Phone: 870-836-8132
  • Fax: 870-836-9314
Mailing address:
  • Phone: 870-836-8132
  • Fax: 870-836-9314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD09491
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: