Provider Demographics
NPI:1609862879
Name:STOVER, MIKE (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:MIKE
Middle Name:
Last Name:STOVER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 CAMDEN RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-8480
Mailing Address - Country:US
Mailing Address - Phone:870-879-1490
Mailing Address - Fax:870-879-1920
Practice Address - Street 1:3800 CAMDEN RD
Practice Address - Street 2:SUITE 1
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-8480
Practice Address - Country:US
Practice Address - Phone:870-879-1490
Practice Address - Fax:870-879-1920
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-23
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR08219183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR08219OtherPHARMACY LICENSE