Healthcare Provider Details

I. General information

NPI: 1497662159
Provider Name (Legal Business Name): MAYA RENA ROUSE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5905 DOLLARWAY RD
WHITE HALL AR
71602-3825
US

IV. Provider business mailing address

2605 E 10TH AVE
PINE BLUFF AR
71601-5502
US

V. Phone/Fax

Practice location:
  • Phone: 870-534-7868
  • Fax: 870-534-4677
Mailing address:
  • Phone: 870-329-7652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD17859
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: