Provider Demographics
NPI:1679856215
Name:MCCULLOUGH, CASSIE NICOLA (PHARMD)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:NICOLA
Last Name:MCCULLOUGH
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 1:1204 SE 28TH ST
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3881
Mailing Address - Country:US
Mailing Address - Phone:844-414-5805
Mailing Address - Fax:
Practice Address - Street 1:1204 SE 28TH ST
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3881
Practice Address - Country:US
Practice Address - Phone:844-414-5805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD11625183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist