Healthcare Provider Details

I. General information

NPI: 1902956246
Provider Name (Legal Business Name): ANDREA TAYLOR PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 04/28/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1243 HIGHWAY 62 412
HIGHLAND AR
72542-9469
US

IV. Provider business mailing address

PO BOX 428
ASH FLAT AR
72513-0428
US

V. Phone/Fax

Practice location:
  • Phone: 870-856-3080
  • Fax: 870-856-4165
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberAR9351
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: