Provider Demographics
NPI:1245830686
Name:PRUITT, REBEKAH JANE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:REBEKAH
Middle Name:JANE
Last Name:PRUITT
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 1:268 DUGGER RD
Mailing Address - Street 2:
Mailing Address - City:BEEBE
Mailing Address - State:AR
Mailing Address - Zip Code:72012-3817
Mailing Address - Country:US
Mailing Address - Phone:501-940-5432
Mailing Address - Fax:
Practice Address - Street 1:2003 W CENTER ST
Practice Address - Street 2:
Practice Address - City:BEEBE
Practice Address - State:AR
Practice Address - Zip Code:72012-2544
Practice Address - Country:US
Practice Address - Phone:501-882-1516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD08855183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPD08855OtherAR STATE BOARD OF PHARMACY