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General NPI Number Information
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NPI Number | 1790596971
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Entity Type | Individual
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Provider Name | TAYLOR MARIE WAKEFIELD PHARMD
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Gender | Female
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Dates
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Enumeration Date | 01/16/2025
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 1901 ENCORE WAY
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City | BRYANT
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State | AR
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Zip | 72019-8896
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Country | US
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Telephone | 501-213-4248
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Fax |
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Provider Business Mailing Address
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Address Line | 800 BUMPUS RD
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City | ALEXANDER
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State | AR
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Zip | 72002-2837
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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 | PD15059
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License Number State | AR
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