Provider Demographics
NPI:1619547668
Name:BALLEK, KAITLIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:BALLEK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:
Other - Last Name:MORKASSEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1207 WALROSE CIR
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-9567
Mailing Address - Country:US
Mailing Address - Phone:618-339-2693
Mailing Address - Fax:
Practice Address - Street 1:1325 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-2458
Practice Address - Country:US
Practice Address - Phone:501-941-3131
Practice Address - Fax:501-941-3137
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD15820183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist