Healthcare Provider Details

I. General information

NPI: 1811814932
Provider Name (Legal Business Name): MEAGAN WALLACE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS WAY
LITTLE ROCK AR
72202-3500
US

IV. Provider business mailing address

4216 BOWMAN RD APT F2
LITTLE ROCK AR
72210-2389
US

V. Phone/Fax

Practice location:
  • Phone: 501-424-7208
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD17406
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: