Provider Demographics
NPI:1518567833
Name:CASTLEBERRY, MIKALA (PD)
Entity Type:Individual
Prefix:
First Name:MIKALA
Middle Name:
Last Name:CASTLEBERRY
Suffix:
Gender:F
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3509 E RACE AVE
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-6202
Mailing Address - Country:US
Mailing Address - Phone:501-268-4946
Mailing Address - Fax:
Practice Address - Street 1:3509 E RACE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-6202
Practice Address - Country:US
Practice Address - Phone:501-268-4849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD007807183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist