Provider Demographics
NPI:1710580402
Name:YINGLING, MEGAN NICOLE
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:NICOLE
Last Name:YINGLING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4955 CANAL PL
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-7537
Mailing Address - Country:US
Mailing Address - Phone:501-339-1955
Mailing Address - Fax:
Practice Address - Street 1:2550 PRINCE ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-3756
Practice Address - Country:US
Practice Address - Phone:501-205-7265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD15076183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist