Healthcare Provider Details

I. General information

NPI: 1518562636
Provider Name (Legal Business Name): JONELL RENAE HUDSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W MAPLE AVE STE 102
SPRINGDALE AR
72764-5370
US

IV. Provider business mailing address

2427 WILLOW BEND CIR
SPRINGDALE AR
72762-7443
US

V. Phone/Fax

Practice location:
  • Phone: 479-750-6585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number8197
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: