Healthcare Provider Details

I. General information

NPI: 1306524962
Provider Name (Legal Business Name): TOMA GALE MENOTTI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 07/05/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 US HWY 425 SOUTH
MONTICELLO AR
71655
US

IV. Provider business mailing address

421 MEADOWVIEW DR
MONTICELLO AR
71655-3817
US

V. Phone/Fax

Practice location:
  • Phone: 870-367-3559
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD16588
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: