Provider Demographics
NPI:1043584717
Name:STOLL, TARA NIKOLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:NIKOLE
Last Name:STOLL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 ATWOOD RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206-6012
Mailing Address - Country:US
Mailing Address - Phone:501-888-7514
Mailing Address - Fax:501-888-7504
Practice Address - Street 1:3401 ATWOOD RD
Practice Address - Street 2:SUITE F
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72206-6012
Practice Address - Country:US
Practice Address - Phone:501-888-7514
Practice Address - Fax:501-888-7504
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD09311183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist