Healthcare Provider Details

I. General information

NPI: 1851770952
Provider Name (Legal Business Name): ALANA ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALANA BURNETTE

II. Dates (important events)

Enumeration Date: 05/21/2015
Last Update Date: 05/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 S MAIN ST
STUTTGART AR
72160-4355
US

IV. Provider business mailing address

218 S MAIN ST
STUTTGART AR
72160-4355
US

V. Phone/Fax

Practice location:
  • Phone: 870-673-2691
  • Fax: 870-673-2651
Mailing address:
  • Phone: 870-673-2691
  • Fax: 870-673-2651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD12128
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: