Provider Demographics
NPI:1427011592
Name:MCCULLOUGH, VADA BETH (RPH)
Entity Type:Individual
Prefix:
First Name:VADA
Middle Name:BETH
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 PASSION PLAY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:EUREKA SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72632-9495
Mailing Address - Country:US
Mailing Address - Phone:479-253-9751
Mailing Address - Fax:479-253-7149
Practice Address - Street 1:146 PASSION PLAY RD
Practice Address - Street 2:SUITE B
Practice Address - City:EUREKA SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72632-9495
Practice Address - Country:US
Practice Address - Phone:479-253-9751
Practice Address - Fax:479-253-7149
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD09230183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist