Provider Demographics
NPI:1710598578
Name:MYRES, PAULA JEAN
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:JEAN
Last Name:MYRES
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 1:9 CARRIAGE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-2278
Mailing Address - Country:US
Mailing Address - Phone:501-837-0804
Mailing Address - Fax:
Practice Address - Street 1:640 W GAINES ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-4675
Practice Address - Country:US
Practice Address - Phone:870-367-6146
Practice Address - Fax:870-367-7016
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR07947183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist