Provider Demographics
NPI:1720852619
Name:FENTON, EMBER RAI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EMBER
Middle Name:RAI
Last Name:FENTON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:EMBER
Other - Middle Name:RAI
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4301 W MARKHAM ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7199
Mailing Address - Country:US
Mailing Address - Phone:501-686-5530
Mailing Address - Fax:601-686-5055
Practice Address - Street 1:4301 W MARKHAM STREET
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205
Practice Address - Country:US
Practice Address - Phone:501-686-5530
Practice Address - Fax:501-686-5055
Is Sole Proprietor?:No
Enumeration Date:2023-11-10
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD15887183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist