Provider Demographics
NPI:1134498868
Name:BAIN, WENDY D (PHARMD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:D
Last Name:BAIN
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:PO BOX 491
Mailing Address - Street 2:
Mailing Address - City:NORPHLET
Mailing Address - State:AR
Mailing Address - Zip Code:71759-0491
Mailing Address - Country:US
Mailing Address - Phone:870-546-2704
Mailing Address - Fax:
Practice Address - Street 1:2135 N WEST AVE
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-3351
Practice Address - Country:US
Practice Address - Phone:870-862-5458
Practice Address - Fax:870-862-0076
Is Sole Proprietor?:No
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR09224183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist