Provider Demographics
NPI:1477226090
Name:INGRAM, MCKINLIE ALEXIS (PHARMD)
Entity Type:Individual
Prefix:
First Name:MCKINLIE
Middle Name:ALEXIS
Last Name:INGRAM
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 1:26559 S SARDIS RD
Mailing Address - Street 2:
Mailing Address - City:BAUXITE
Mailing Address - State:AR
Mailing Address - Zip Code:72011-8044
Mailing Address - Country:US
Mailing Address - Phone:501-589-5341
Mailing Address - Fax:
Practice Address - Street 1:26559 S SARDIS RD
Practice Address - Street 2:
Practice Address - City:BAUXITE
Practice Address - State:AR
Practice Address - Zip Code:72011-8044
Practice Address - Country:US
Practice Address - Phone:501-589-5341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD15852183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist