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General NPI Number Information
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NPI Number | 1306446323
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Entity Type | Individual
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Provider Name | ALYSSA CHARLTON
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Gender | Female
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Dates
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Enumeration Date | 10/28/2020
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Last Update Date | 10/28/2020
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Provider Practice Location Address
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Address Line | 1517 GENE GEORGE BLVD
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City | SPRINGDALE
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State | AR
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Zip | 72762-0716
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Country | US
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Telephone | 479-365-8134
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Fax | 479-365-8133
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Provider Business Mailing Address
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Address Line | 6200 W TUMBLER RDG
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City | ROGERS
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State | AR
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Zip | 72758-4035
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Country | US
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Telephone | 479-366-2621
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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 | 2013022789
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PD13093
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License Number State | AR
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