Provider Demographics
NPI:1942804034
Name:JEFFREY, ERIN JAYE
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:JAYE
Last Name:JEFFREY
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 1:420 S UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5246
Mailing Address - Country:US
Mailing Address - Phone:501-801-3413
Mailing Address - Fax:501-801-3414
Practice Address - Street 1:420 S UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5246
Practice Address - Country:US
Practice Address - Phone:501-801-3413
Practice Address - Fax:501-801-3414
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD14565183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist