Provider Demographics
NPI:1356407571
Name:MCVEY, BLENDA PAULETTE (PD)
Entity type:Individual
Prefix:
First Name:BLENDA
Middle Name:PAULETTE
Last Name:MCVEY
Suffix:
Gender:F
Credentials:PD
Other - Prefix:
Other - First Name:BLENDA
Other - Middle Name:PAULETTE
Other - Last Name:HOLLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:376 CAMPGROUND RD
Mailing Address - Street 2:
Mailing Address - City:BEEBE
Mailing Address - State:AR
Mailing Address - Zip Code:72012-9602
Mailing Address - Country:US
Mailing Address - Phone:501-882-2041
Mailing Address - Fax:501-882-7149
Practice Address - Street 1:1903 W DEWITT HENRY DR
Practice Address - Street 2:
Practice Address - City:BEEBE
Practice Address - State:AR
Practice Address - Zip Code:72012-2028
Practice Address - Country:US
Practice Address - Phone:501-882-6471
Practice Address - Fax:501-882-7149
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD07040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist