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Individual

IMI MVERE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
178 HIGHWAY 167 N, BALD KNOB, AR 72010-4058
(501) 724-2391
Mailing address
PO BOX 211, WARD, AR 72176-0211

Taxonomy

Speciality
Code
Description
License number
State
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
PD14636
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
PD14636
ARKANSAS STATE PHARMACIST LICENSE
AR
Enumeration date
10/15/2018
Last updated
10/15/2018
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