Provider Demographics
NPI:1497890297
Name:RUBOTTOM, ANDREA R (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:R
Last Name:RUBOTTOM
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 1:162 COUNTY ROAD 7452
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7951
Mailing Address - Country:US
Mailing Address - Phone:870-931-9556
Mailing Address - Fax:
Practice Address - Street 1:2905 E NETTLETON AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4534
Practice Address - Country:US
Practice Address - Phone:870-932-6930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR8904183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist