Provider Demographics
NPI:1356635460
Name:DAVENPORT, BETH ANN (PHARMD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:ANN
Other - Last Name:PONDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2509 MCCAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-7606
Mailing Address - Country:US
Mailing Address - Phone:501-758-9307
Mailing Address - Fax:501-758-9308
Practice Address - Street 1:2509 MCCAIN BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-7606
Practice Address - Country:US
Practice Address - Phone:501-758-9307
Practice Address - Fax:501-758-9308
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD11290183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist