Healthcare Provider Details

I. General information

NPI: 1225477136
Provider Name (Legal Business Name): HEATHER RENEE RENICO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER RENICO HEATHER REDDELL

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 01/01/2026
Certification Date: 01/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 HIGHWAY 62 65 N
HARRISON AR
72601-2152
US

IV. Provider business mailing address

705 HIGHWAY 62 65 N
HARRISON AR
72601-2152
US

V. Phone/Fax

Practice location:
  • Phone: 870-365-0459
  • Fax: 870-365-0186
Mailing address:
  • Phone: 870-365-0459
  • Fax: 870-365-0186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS019810
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: