Basic Information
| Provider Information | |||||||||
| NPI: | 1306446323 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHARLTON | ||||||||
| FirstName: | ALYSSA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6200 W TUMBLER RDG | ||||||||
| Address2: | |||||||||
| City: | ROGERS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727584035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4793662621 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1517 GENE GEORGE BLVD | ||||||||
| Address2: | |||||||||
| City: | SPRINGDALE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727620716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4793658134 | ||||||||
| FaxNumber: | 4793658133 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2020 | ||||||||
| LastUpdateDate: | 10/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 2013022789 | MO | N | Pharmacy Service Providers | Pharmacist | 183500000X | PD13093 | AR | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.