Healthcare Provider Details

I. General information

NPI: 1891199691
Provider Name (Legal Business Name): ANDREW MIZE PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2014
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5403 W PINNACLE POINTE DR
ROGERS AR
72758-8118
US

IV. Provider business mailing address

5403 W PINNACLE POINTE DR
ROGERS AR
72758-8118
US

V. Phone/Fax

Practice location:
  • Phone: 479-271-6300
  • Fax: 479-271-6305
Mailing address:
  • Phone: 479-271-6300
  • Fax: 479-271-6305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD11643
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: