Healthcare Provider Details

I. General information

NPI: 1689403727
Provider Name (Legal Business Name): LAUREN MACKENZIE ROMO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 07/29/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3545 N SHILOH DR
FAYETTEVILLE AR
72703-5359
US

IV. Provider business mailing address

2750 W. OBSIDIAN ST.
FAYETTEVILLE AR
72704
US

V. Phone/Fax

Practice location:
  • Phone: 479-443-5628
  • Fax:
Mailing address:
  • Phone: 479-233-9346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD17039
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: