Jennie Elizabeth Staten, PHARMD – Pharmacist

Key facts

NPI: 1740958685
Entity type: Individual (NPI type 1)
Primary specialty: Pharmacist 183500000X
License: PD15060 (AR)
Practice address: 535 Jordan Dr Ste B
Monticello, AR 71655-5714
Phone: (870) 224-0650
Fax: (870) 224-0652
NPI assigned: Sep 3, 2021
Sex: Female
Sole proprietor: Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Mainline Pharmacy Services Inc Community/Retail Pharmacy · Monticello, AR · NPI 1013589514

NPD

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
PD15060	AR	MD	Pharmacist

Practice roles

Organization	Specialty	Status	New patients
Mainline Pharmacy Services Inc		Current since Sep 5, 2021	Accepting new patients

Locations

535 Jordan Dr
Ste B
Monticello, AR 71655
Phone (870) 224-0650

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Pharmacist	183500000X	PD15060	AR	Yes

Addresses

Primary practice location

535 Jordan Dr Ste B
Monticello, AR 71655-5714

Mailing address

535 Jordan Dr Ste B
Monticello, AR 71655-5714
Phone (870) 224-0650

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 3, 2021.

{
    "created_epoch": "1630627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630627200000",
    "number": "1740958685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "535 JORDAN DR STE B",
            "city": "MONTICELLO",
            "state": "AR",
            "postal_code": "716555714",
            "telephone_number": "870-224-0650",
            "fax_number": "870-224-0652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 JORDAN DR STE B",
            "city": "MONTICELLO",
            "state": "AR",
            "postal_code": "716555714",
            "telephone_number": "870-224-0650",
            "fax_number": "870-224-0652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STATEN",
        "first_name": "JENNIE",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-09-03",
        "last_updated": "2021-09-03",
        "certification_date": "2021-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "AR",
            "license": "PD15060",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Monticello, AR

All providers in Monticello, AR · Pharmacist in Arkansas

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 3, 2021. 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.

Verify at the official NPI Registry.