MEDICARE: MRS. CONNIE L. MEDSKER P.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	08095	AR

General Provider Information

NPI Number	:	1174674394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CONNIE L. MEDSKER P.D.

Provider Business Mailing Address
First Line	:	PO BOX L
Second Line	:	121 NORTH COURT STREET
City	:	CARLISLE
State	:	AR
Zip	:	72024-1512
Country	:	US
Telephone Number	:	870-552-7837
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 NORTH COURT
Second Line	:
City	:	CARLISLE
State	:	AR
Zip	:	72024-1512
Country	:	US
Telephone Number	:	870-552-7837
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	06/01/2022

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