Provider Demographics
NPI:1326770124
Name:COULTER, MARY KATELYN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:KATELYN
Last Name:COULTER
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 1:121 N COMMERCE AVE
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-3741
Mailing Address - Country:US
Mailing Address - Phone:479-968-2456
Mailing Address - Fax:479-968-7914
Practice Address - Street 1:121 N COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-3790
Practice Address - Country:US
Practice Address - Phone:479-968-2456
Practice Address - Fax:479-968-7914
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD12364183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist