Provider Demographics
NPI:1437532892
Name:SMITH, KILEY (PHARM D)
Entity Type:Individual
Prefix:
First Name:KILEY
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1713 BELLEFONTE RD
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-7004
Mailing Address - Country:US
Mailing Address - Phone:870-688-1719
Mailing Address - Fax:
Practice Address - Street 1:1713 BELLEFONTE RD
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-7004
Practice Address - Country:US
Practice Address - Phone:870-688-1719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD09547183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist