Provider Demographics
NPI:1134567274
Name:BYNUM, AMBER BENNETT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AMBER
Middle Name:BENNETT
Last Name:BYNUM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 CANTRELL RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-2116
Mailing Address - Country:US
Mailing Address - Phone:501-707-3607
Mailing Address - Fax:501-707-3603
Practice Address - Street 1:2510 CANTRELL RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-2116
Practice Address - Country:US
Practice Address - Phone:501-707-3607
Practice Address - Fax:501-707-3603
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD11962183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist