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General NPI Number Information
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NPI Number | 1063834380
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Entity Type | Organization
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Legal Business Name | PHARMACY OF OTTER CREEK
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Dates
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Enumeration Date | 01/07/2014
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Last Update Date | 05/17/2016
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Provider Practice Location Address
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Address Line | 10506 STAGECOACH RD STE F
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City | LITTLE ROCK
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State | AR
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Zip | 72210-8939
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Country | US
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Telephone | 501-455-2522
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Fax |
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Provider Business Mailing Address
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Address Line | 10506 STAGECOACH RD STE F
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City | LITTLE ROCK
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State | AR
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Zip | 72210-8939
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Country | US
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Telephone | 501-455-2522
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Fax |
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | BELYNDA F BAKER
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Credential | PHARM. D.
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Telephone | 501-455-2522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PD09193
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License Number State | AR
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