=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669758371
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHAKERA RENETTE READY PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2011
-----------------------------------------------------
Last Update Date | 10/26/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5917 BASELINE RD
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72209-5046
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-565-7844
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9100 PEACH TREE LN
-----------------------------------------------------
City | SHERWOOD
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72120-3900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-835-5092
-----------------------------------------------------
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 | PD11499
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------