Healthcare Provider Details

I. General information

NPI: 1215639091
Provider Name (Legal Business Name): AMANDA LEIGH ELCHYNSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS WAY # 304
LITTLE ROCK AR
72202-3500
US

IV. Provider business mailing address

111 S MCKINLEY ST APT 4307
LITTLE ROCK AR
72205-2068
US

V. Phone/Fax

Practice location:
  • Phone: 501-364-2835
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPD15921
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: