Healthcare Provider Details

I. General information

NPI: 1073935979
Provider Name (Legal Business Name): KAILEY CHATELAIN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2014
Last Update Date: 01/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 MC 7031
FLIPPIN AR
72634-8347
US

IV. Provider business mailing address

1370 MC 7031
FLIPPIN AR
72634-8347
US

V. Phone/Fax

Practice location:
  • Phone: 870-577-1029
  • Fax:
Mailing address:
  • Phone: 870-577-1029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD10804
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: