Provider Demographics
NPI:1235726258
Name:LAND, KATIE ELLEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:ELLEN
Last Name:LAND
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:ELLEN
Other - Last Name:MCDILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:909 UNITY RD
Mailing Address - Street 2:
Mailing Address - City:CROSSETT
Mailing Address - State:AR
Mailing Address - Zip Code:71635-9444
Mailing Address - Country:US
Mailing Address - Phone:870-364-5100
Mailing Address - Fax:870-364-5120
Practice Address - Street 1:909 UNITY RD
Practice Address - Street 2:
Practice Address - City:CROSSETT
Practice Address - State:AR
Practice Address - Zip Code:71635-9444
Practice Address - Country:US
Practice Address - Phone:870-364-5100
Practice Address - Fax:870-364-5120
Is Sole Proprietor?:No
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD13190183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist