=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053745794
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DEAN'S PHARMACY CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2013
-----------------------------------------------------
Last Update Date | 08/29/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1640 S WHITEHEAD DR
-----------------------------------------------------
City | DE WITT
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72042-2994
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-946-2381
-----------------------------------------------------
Fax | 870-946-4286
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1640 S WHITEHEAD DR
-----------------------------------------------------
City | DE WITT
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72042-2994
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-946-2381
-----------------------------------------------------
Fax | 870-946-4286
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | BRANDYN ENGLAND
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 870-946-2381
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | AR17661
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------