Healthcare Provider Details

I. General information

NPI: 1831116573
Provider Name (Legal Business Name): HOLLY CHAMBLESS VANSANDT PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1626 S MADISON ST
DEWITT AR
72042-3003
US

IV. Provider business mailing address

PO BOX 203
SAINT CHARLES AR
72140-0203
US

V. Phone/Fax

Practice location:
  • Phone: 870-946-1706
  • Fax: 870-946-3024
Mailing address:
  • Phone: 870-282-8013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8734
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: