Healthcare Provider Details

I. General information

NPI: 1528341534
Provider Name (Legal Business Name): AMANDA ELIZABETH NICHOLS BS PHARMACY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 CREPE MYRTLE DR
JONESBORO AR
72401-7829
US

IV. Provider business mailing address

1706 CREPE MYRTLE DR
JONESBORO AR
72401-7829
US

V. Phone/Fax

Practice location:
  • Phone: 870-268-1442
  • Fax: 870-268-1463
Mailing address:
  • Phone: 870-268-1442
  • Fax: 870-268-1463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberAR 07140
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: