Healthcare Provider Details

I. General information

NPI: 1871196634
Provider Name (Legal Business Name): MARIYA YEMETS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 S ROCK ST
SHERIDAN AR
72150-7160
US

IV. Provider business mailing address

7321 ILLINOIS ST
LITTLE ROCK AR
72207-6035
US

V. Phone/Fax

Practice location:
  • Phone: 870-942-5045
  • Fax:
Mailing address:
  • Phone: 479-305-8654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD15453
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: