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General NPI Number Information
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NPI Number | 1740879931
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Entity Type | Individual
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Provider Name | JAMIE CAROL IVY PHARMD
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Gender | Female
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Dates
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Enumeration Date | 01/13/2021
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Last Update Date | 01/13/2021
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Provider Practice Location Address
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Address Line | 120 S 4TH ST
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City | HEBER SPRINGS
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State | AR
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Zip | 72543-3810
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Country | US
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Telephone | 501-362-5853
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Fax | 501-500-6380
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Provider Business Mailing Address
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Address Line | 120 S 4TH ST
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City | HEBER SPRINGS
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State | AR
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Zip | 72543-3810
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Country | US
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Telephone | 501-362-5853
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Fax | 501-500-6380
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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 | PD10356
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License Number State | AR
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