=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497662159
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAYA RENA ROUSE PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2026
-----------------------------------------------------
Last Update Date | 08/26/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5905 DOLLARWAY RD
-----------------------------------------------------
City | WHITE HALL
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71602-3825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-534-7868
-----------------------------------------------------
Fax | 870-534-4677
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2605 E 10TH AVE
-----------------------------------------------------
City | PINE BLUFF
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71601-5502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-329-7652
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PD17859
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------