Healthcare Provider Details

I. General information

NPI: 1831710367
Provider Name (Legal Business Name): BAILEY NICOLE BREWER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BAILEY NICOLE WILLIAMS PHARMD

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 DAVE WARD DR STE 602
CONWAY AR
72034-8685
US

IV. Provider business mailing address

2425 DAVE WARD DR STE 602
CONWAY AR
72034-8685
US

V. Phone/Fax

Practice location:
  • Phone: 501-336-8188
  • Fax: 501-336-8177
Mailing address:
  • Phone: 501-336-8188
  • Fax: 501-336-8177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD14045
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: