Healthcare Provider Details

I. General information

NPI: 1366170573
Provider Name (Legal Business Name): HAILEY KENDREX PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8801 HIGHWAY 107
SHERWOOD AR
72120-2929
US

IV. Provider business mailing address

1633 ROCKWATER BLVD APT 108
NORTH LITTLE ROCK AR
72114-4259
US

V. Phone/Fax

Practice location:
  • Phone: 501-833-3116
  • Fax:
Mailing address:
  • Phone: 870-277-8492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD15902
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: