Provider Demographics
NPI:1518563378
Name:MALLORY, CAROLINE KENDRICK (PHARMD)
Entity Type:Individual
Prefix:MISS
First Name:CAROLINE
Middle Name:KENDRICK
Last Name:MALLORY
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 1:834 E HENRI DE TONTI BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-4124
Mailing Address - Country:US
Mailing Address - Phone:479-927-6100
Mailing Address - Fax:
Practice Address - Street 1:834 E HENRI DE TONTI BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-4124
Practice Address - Country:US
Practice Address - Phone:479-927-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD13693183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist