MEDICARE: VADA BETH MCCULLOUGH RPH

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	PD09230	AR

General Provider Information

NPI Number	:	1427011592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VADA BETH MCCULLOUGH RPH

Provider Business Mailing Address
First Line	:	146 PASSION PLAY RD
Second Line	:	SUITE B
City	:	EUREKA SPRINGS
State	:	AR
Zip	:	72632-9495
Country	:	US
Telephone Number	:	479-253-9751
Fax Number	:	479-253-7149

Provider Business Practice Location Address
First Line	:	146 PASSION PLAY RD
Second Line	:	SUITE B
City	:	EUREKA SPRINGS
State	:	AR
Zip	:	72632-9495
Country	:	US
Telephone Number	:	479-253-9751
Fax Number	:	479-253-7149

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

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	08/06/2013

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