Provider Demographics
NPI:1346837960
Name:REBSTOCK, MANDY DENISE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:DENISE
Last Name:REBSTOCK
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 1:648 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PIGGOTT
Mailing Address - State:AR
Mailing Address - Zip Code:72454-2907
Mailing Address - Country:US
Mailing Address - Phone:870-598-3183
Mailing Address - Fax:870-598-3183
Practice Address - Street 1:648 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PIGGOTT
Practice Address - State:AR
Practice Address - Zip Code:72454-2907
Practice Address - Country:US
Practice Address - Phone:870-598-3183
Practice Address - Fax:870-598-3183
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD12858183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist