Provider Demographics
NPI:1073935979
Name:CHATELAIN, KAILEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:KAILEY
Middle Name:
Last Name:CHATELAIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 MC 7031
Mailing Address - Street 2:
Mailing Address - City:FLIPPIN
Mailing Address - State:AR
Mailing Address - Zip Code:72634-8347
Mailing Address - Country:US
Mailing Address - Phone:870-577-1029
Mailing Address - Fax:
Practice Address - Street 1:1370 MC 7031
Practice Address - Street 2:
Practice Address - City:FLIPPIN
Practice Address - State:AR
Practice Address - Zip Code:72634-8347
Practice Address - Country:US
Practice Address - Phone:870-577-1029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD10804183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist