Healthcare Provider Details

I. General information

NPI: 1932530268
Provider Name (Legal Business Name): KRISTIN AHLERT PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2013
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 W MAIN ST
LAVACA AR
72941-3802
US

IV. Provider business mailing address

1800 W MAIN ST
LAVACA AR
72941-3802
US

V. Phone/Fax

Practice location:
  • Phone: 479-674-2222
  • Fax:
Mailing address:
  • Phone: 479-674-2222
  • Fax: 479-674-2224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD10847
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: