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General NPI Number Information
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NPI Number | 1699345413
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Entity Type | Individual
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Provider Name | DR. JENNY CARAWAY
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Gender | Female
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Dates
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Enumeration Date | 06/25/2021
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Last Update Date | 06/25/2021
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Provider Practice Location Address
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Address Line | 240 SLACK ST
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City | PEA RIDGE
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State | AR
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Zip | 72751-3759
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Country | US
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Telephone | 479-451-9008
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Fax |
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Provider Business Mailing Address
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Address Line | 6201 SW WARRINGTON RD
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City | BENTONVILLE
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State | AR
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Zip | 72713-2200
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Country | US
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Telephone |
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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 | PD13198
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License Number State | AR
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