MEDICARE: KATY DENISE BOSTIC PHARM 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	PD09491	AR

General Provider Information

NPI Number	:	1801488226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATY DENISE BOSTIC PHARM D

Provider Business Mailing Address
First Line	:	1286 HIGHWAY 278 BYP
Second Line	:
City	:	CAMDEN
State	:	AR
Zip	:	71701-4552
Country	:	US
Telephone Number	:	870-836-8132
Fax Number	:	870-836-9314

Provider Business Practice Location Address
First Line	:	1286 HIGHWAY 278 BYP
Second Line	:
City	:	CAMDEN
State	:	AR
Zip	:	71701-4552
Country	:	US
Telephone Number	:	870-836-8132
Fax Number	:	870-836-9314

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

Provider Enumeration Date	:	02/08/2021
Last Update Date	:	02/08/2021

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Directions to “ KATY DENISE BOSTIC PHARM D” Practice Location

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