Healthcare Provider Details

I. General information

NPI: 1952949448
Provider Name (Legal Business Name): ALLIE DANIELLE STATON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2019
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13907 HIGH RD
MABELVALE AR
72103-3212
US

IV. Provider business mailing address

9064 ROLLING HILLS DR
ALEXANDER AR
72002-2896
US

V. Phone/Fax

Practice location:
  • Phone: 501-451-7715
  • Fax:
Mailing address:
  • Phone: 501-837-0811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPD14602
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPD14602
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: