Healthcare Provider Details

I. General information

NPI: 1518010396
Provider Name (Legal Business Name): JENNIFER E STARK PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 02/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5826 DANCING RABBIT DR
SPRINGDALE AR
72762-6277
US

IV. Provider business mailing address

5826 DANCING RABBIT DR
SPRINGDALE AR
72762-6277
US

V. Phone/Fax

Practice location:
  • Phone: 479-304-8889
  • Fax:
Mailing address:
  • Phone: 479-304-8889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number12873
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPD10961
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: