Provider Demographics
NPI:1114671732
Name:FLIPPO, KERA COLETTE (RPH)
Entity Type:Individual
Prefix:
First Name:KERA
Middle Name:COLETTE
Last Name:FLIPPO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4742 COPPER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-8752
Mailing Address - Country:US
Mailing Address - Phone:870-759-0268
Mailing Address - Fax:
Practice Address - Street 1:2503 W PLEASANT GROVE RD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1448
Practice Address - Country:US
Practice Address - Phone:479-936-8079
Practice Address - Fax:479-936-8657
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD15983183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty