Healthcare Provider Details

I. General information

NPI: 1790653483
Provider Name (Legal Business Name): ERIN ELIZABETH MANGUM PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2025
Last Update Date: 10/25/2025
Certification Date: 10/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 S RIFE MEDICAL LN
ROGERS AR
72758-1452
US

IV. Provider business mailing address

1648 E MISSION BLVD
FAYETTEVILLE AR
72703-3043
US

V. Phone/Fax

Practice location:
  • Phone: 479-338-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number0202213795
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPD12272
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: