Jennifer Leigh Tackett, PHARM.D.
Individual provider Active NPI Pharmacist · Dover, AR
NPI 1720198989 · NPPES record last updated Oct 14, 2022
Key facts
- NPI
- 1720198989
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- PD09706 (AR)
- Practice address
- 8880 Market St
Dover, AR 72837-9111 - Phone
- (479) 331-2133
- Fax
- (479) 331-4003
- NPI assigned
- Aug 30, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PD09706 | AR | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rose Drug of Dover Inc | Past | Accepting new patients | |
| Rose Drug of Dover Inc | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PD09706 | AR | Yes |
Addresses
Primary practice location
8880 Market St
Dover, AR 72837-9111
Mailing address
12838 Sr 333
Dover, AR 72837-9123
Other providers in Dover, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 14, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.