Provider Demographics
NPI:1073152351
Name:SHOEMAKER, JAMIE W
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:W
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 PINE BLUFF HWY
Mailing Address - Street 2:
Mailing Address - City:ENGLAND
Mailing Address - State:AR
Mailing Address - Zip Code:72046-2237
Mailing Address - Country:US
Mailing Address - Phone:501-842-3471
Mailing Address - Fax:
Practice Address - Street 1:301 PINE BLUFF HWY
Practice Address - Street 2:
Practice Address - City:ENGLAND
Practice Address - State:AR
Practice Address - Zip Code:72046-2237
Practice Address - Country:US
Practice Address - Phone:501-842-3471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD07032183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist