Provider Demographics
NPI:1154041689
Name:REAVES, ISABELLE DIANE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ISABELLE
Middle Name:DIANE
Last Name:REAVES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 W SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-4258
Mailing Address - Country:US
Mailing Address - Phone:501-778-3151
Mailing Address - Fax:501-778-7329
Practice Address - Street 1:620 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-4258
Practice Address - Country:US
Practice Address - Phone:501-778-3151
Practice Address - Fax:501-778-7329
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD16277183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist