Provider Demographics
NPI:1700043486
Name:KING, TABITHA MARY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TABITHA
Middle Name:MARY
Last Name:KING
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:TABITHA
Other - Middle Name:MARY
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:421 N SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-3840
Mailing Address - Country:US
Mailing Address - Phone:901-828-3871
Mailing Address - Fax:
Practice Address - Street 1:421 N SPRUCE ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-3840
Practice Address - Country:US
Practice Address - Phone:901-828-3871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32983183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist