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General NPI Number Information
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NPI Number | 1023619954
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Entity Type | Individual
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Provider Name | DYLAN JAMES LEDET PHARMD
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Gender | Male
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Dates
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Enumeration Date | 11/06/2020
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Last Update Date | 11/06/2020
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Provider Practice Location Address
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Address Line | 5000 W PAULINE WHITAKER PKWY
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City | ROGERS
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State | AR
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Zip | 72758-9104
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Country | US
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Telephone | 479-254-6806
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Fax |
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Provider Business Mailing Address
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Address Line | 3302 SW PEBBLE ST APT 25
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City | BENTONVILLE
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State | AR
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Zip | 72713-5646
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Country | US
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Telephone | 985-438-5965
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PD15425
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License Number State | AR
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