Provider Demographics
NPI:1134729924
Name:FORD, SHONDRANIKA CERISE (PHARMD)
Entity type:Individual
Prefix:
First Name:SHONDRANIKA
Middle Name:CERISE
Last Name:FORD
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 1:297 HWY 32 BYPASS E
Mailing Address - Street 2:
Mailing Address - City:ASHDOWN
Mailing Address - State:AR
Mailing Address - Zip Code:71822
Mailing Address - Country:US
Mailing Address - Phone:870-898-2142
Mailing Address - Fax:
Practice Address - Street 1:297 HWY 32 BYPASS E
Practice Address - Street 2:
Practice Address - City:ASHDOWN
Practice Address - State:AR
Practice Address - Zip Code:71822
Practice Address - Country:US
Practice Address - Phone:870-898-2142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65407183500000X
LAPST.022920183500000X
ARPD14659183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist