=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699891507
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GAIL A NORTHCUTT PD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 202 S MAIN ST
-----------------------------------------------------
City | STUTTGART
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72160-4355
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-673-1311
-----------------------------------------------------
Fax | 870-673-3685
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2008 BEUMER ST
-----------------------------------------------------
City | STUTTGART
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72160-6422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-672-1576
-----------------------------------------------------
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 | 6170
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------