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General NPI Number Information
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NPI Number | 1023636610
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Entity Type | Individual
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Provider Name | DOMONIQUE DESHEA WADLEY PHARMD
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Gender | Female
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Dates
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Enumeration Date | 07/09/2020
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Last Update Date | 07/10/2020
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Provider Practice Location Address
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Address Line | 998 SHADY GROVE RD STE 1H
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City | HOT SPRINGS
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State | AR
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Zip | 71901-8094
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Country | US
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Telephone | 501-262-5400
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Fax | 501-262-5404
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Provider Business Mailing Address
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Address Line | 208 LACROSSE ST
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City | HOT SPRINGS
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State | AR
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Zip | 71913-9553
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Country | US
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Telephone | 501-655-2933
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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 | PD15023
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License Number State | AR
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