Provider Demographics
NPI:1831100627
Name:O'NEAL, STEPHANIE GOODART (RPH)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:GOODART
Last Name:O'NEAL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:H
Other - Last Name:GOODHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PD
Mailing Address - Street 1:PO BOX 757
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-0757
Mailing Address - Country:US
Mailing Address - Phone:870-238-8531
Mailing Address - Fax:870-238-5982
Practice Address - Street 1:718 S FALLS BLVD
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-0757
Practice Address - Country:US
Practice Address - Phone:870-238-8531
Practice Address - Fax:870-238-5982
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR6064183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist