Healthcare Provider Details

I. General information

NPI: 1003689571
Provider Name (Legal Business Name): PAUL RYAN KILLIAN PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 HOSPITAL DR
MOUNTAIN HOME AR
72653-2955
US

IV. Provider business mailing address

PO BOX 684
CALICO ROCK AR
72519-0684
US

V. Phone/Fax

Practice location:
  • Phone: 870-508-1377
  • Fax: 870-508-1315
Mailing address:
  • Phone: 870-404-2830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License NumberPD10801
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: