Individual
MADELINE PHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1189 N GARLAND AVE, FAYETTEVILLE, AR 72703-1682
(479) 444-7967
Mailing address
9809 BROADWELL RD, FORT SMITH, AR 72908-8688
(479) 739-4876
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PD16240
AR
Other
Enumeration date
07/13/2022
Last updated
07/13/2022
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