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General NPI Number Information
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NPI Number | 1679273189
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Entity Type | Individual
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Provider Name | SHELBY WALL PHARMD
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Gender | Female
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Dates
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Enumeration Date | 03/06/2023
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Last Update Date | 03/06/2023
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Provider Practice Location Address
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Address Line | 2701 E HARDING AVE
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City | PINE BLUFF
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State | AR
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Zip | 71601-6849
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Country | US
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Telephone | 870-380-6901
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Fax |
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Provider Business Mailing Address
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Address Line | 4023 HAWTHORNE LN
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City | PINE BLUFF
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State | AR
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Zip | 71603-9030
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Country | US
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Telephone | 501-612-3824
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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 | PD16239
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License Number State | AR
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