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General NPI Number Information
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NPI Number | 1669875035
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Entity Type | Individual
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Provider Name | KARA CHARLES SHIPP PD
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Gender | Male
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Dates
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Enumeration Date | 09/30/2014
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Last Update Date | 09/30/2014
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Provider Practice Location Address
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Address Line | 2125 COLLEGE AVE
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City | CONWAY
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State | AR
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Zip | 72034-6210
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Country | US
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Telephone | 501-327-8088
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Fax |
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Provider Business Mailing Address
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Address Line | 4685 SAWGRASS CV
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City | CONWAY
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State | AR
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Zip | 72034-5007
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Country | US
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Telephone | 501-327-8088
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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 | PD07415
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License Number State | AR
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