Healthcare Provider Details

I. General information

NPI: 1700424637
Provider Name (Legal Business Name): BETH OGDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 S CARAWAY RD
JONESBORO AR
72401-5202
US

IV. Provider business mailing address

1725 S CARAWAY RD
JONESBORO AR
72401-5202
US

V. Phone/Fax

Practice location:
  • Phone: 870-972-5521
  • Fax:
Mailing address:
  • Phone: 870-972-5521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number08892
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPD08892
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: