MEDICARE: JAMES ABBOTT

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	PD12335	AR

General Provider Information

NPI Number	:	1962090852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES ABBOTT

Provider Business Mailing Address
First Line	:	2235 DAVE WARD DR STE 108
Second Line	:
City	:	CONWAY
State	:	AR
Zip	:	72034-7040
Country	:	US
Telephone Number	:	501-450-0000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2235 DAVE WARD DR STE 108
Second Line	:
City	:	CONWAY
State	:	AR
Zip	:	72034-7040
Country	:	US
Telephone Number	:	501-450-0000
Fax Number	:

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

Provider Enumeration Date	:	01/06/2021
Last Update Date	:	01/06/2021

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Directions to “ JAMES ABBOTT ” Practice Location

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