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General NPI Number Information
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NPI Number | 1740958685
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Entity Type | Individual
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Provider Name | JENNIE ELIZABETH STATEN PHARMD
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Gender | Female
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Dates
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Enumeration Date | 09/03/2021
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Last Update Date | 09/03/2021
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Provider Practice Location Address
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Address Line | 535 JORDAN DR STE B
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City | MONTICELLO
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State | AR
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Zip | 71655-5714
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Country | US
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Telephone | 870-224-0650
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Fax | 870-224-0652
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Provider Business Mailing Address
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Address Line | 535 JORDAN DR STE B
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City | MONTICELLO
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State | AR
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Zip | 71655-5714
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Country | US
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Telephone | 870-224-0650
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Fax | 870-224-0652
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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 | PD15060
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License Number State | AR
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