Healthcare Provider Details

I. General information

NPI: 1376829325
Provider Name (Legal Business Name): ELLEN BROOKS TEETER PHARM D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2011
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 W MARKHAM ST
LITTLE ROCK AR
72205-7101
US

IV. Provider business mailing address

48 COMMENTRY DR
LITTLE ROCK AR
72223-4595
US

V. Phone/Fax

Practice location:
  • Phone: 501-686-5530
  • Fax: 501-686-5055
Mailing address:
  • Phone: 501-673-4336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD10542
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: