Provider Demographics
NPI:1841639994
Name:VESTAL, CAROL ANN
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ANN
Last Name:VESTAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1420
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72833-1420
Mailing Address - Country:US
Mailing Address - Phone:479-495-5444
Mailing Address - Fax:479-495-5446
Practice Address - Street 1:518 MEADOW RD
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72802-1829
Practice Address - Country:US
Practice Address - Phone:479-495-5444
Practice Address - Fax:479-495-5446
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR70461835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist