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General NPI Number Information
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NPI Number | 1619547668
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Entity Type | Individual
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Provider Name | KAITLIN BALLEK PHARMD
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Gender | Female
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Dates
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Enumeration Date | 06/30/2021
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Last Update Date | 06/30/2021
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Provider Practice Location Address
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Address Line | 1325 W MAIN ST
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City | CABOT
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State | AR
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Zip | 72023-2458
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Country | US
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Telephone | 501-941-3131
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Fax | 501-941-3137
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Provider Business Mailing Address
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Address Line | 1207 WALROSE CIR
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City | SEARCY
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State | AR
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Zip | 72143-9567
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Country | US
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Telephone | 618-339-2693
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PD15820
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License Number State | AR
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