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General NPI Number Information
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NPI Number | 1609452556
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Entity Type | Individual
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Provider Name | SHELLEY TUSTISON
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Gender | Female
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Dates
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Enumeration Date | 03/22/2021
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Last Update Date | 03/22/2021
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Provider Practice Location Address
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Address Line | 2608 SE J STREET SUITE 8, MAIL SLOT 0230
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City | BENTONVILLE
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State | AR
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Zip | 72716-0001
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Country | US
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Telephone | 479-360-3432
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Fax |
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Provider Business Mailing Address
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Address Line | 1401 SW HAMILTON AVE
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City | BENTONVILLE
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State | AR
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Zip | 72713-5005
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Country | US
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Telephone | 870-919-1873
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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 | PD10815
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License Number State | AR
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