Provider Demographics
NPI:1093816217
Name:DUNLAP, CHRISTINA KAYE
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:KAYE
Last Name:DUNLAP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:CLARENDON
Mailing Address - State:AR
Mailing Address - Zip Code:72029-2001
Mailing Address - Country:US
Mailing Address - Phone:870-747-5625
Mailing Address - Fax:
Practice Address - Street 1:333 MADISON ST.
Practice Address - Street 2:
Practice Address - City:CLARENDON
Practice Address - State:AR
Practice Address - Zip Code:72029
Practice Address - Country:US
Practice Address - Phone:870-747-3304
Practice Address - Fax:870-747-5324
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT87320183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR281107-48-001OtherSTATE SALES TAX
LA1291951Medicaid