Provider Demographics
NPI:1992397319
Name:JEFFUS, ANGELA BRYANT
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:BRYANT
Last Name:JEFFUS
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 1:1286 HIGHWAY 278 BYP
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71701-4552
Mailing Address - Country:US
Mailing Address - Phone:870-836-8131
Mailing Address - Fax:870-836-9314
Practice Address - Street 1:1286 HIGHWAY 278 BYP
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701-4552
Practice Address - Country:US
Practice Address - Phone:870-836-8131
Practice Address - Fax:870-836-9314
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD09073183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist