=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285186874
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAYLA ROGERS PHARMD, BCPS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2016
-----------------------------------------------------
Last Update Date | 08/18/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001 TOWSON AVE
-----------------------------------------------------
City | FORT SMITH
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72901-4921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-441-4000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 435 GUNTHER CIR
-----------------------------------------------------
City | GREENWOOD
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72936-3805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-916-7059
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PHA.0022636
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PST.021661
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------