Provider Demographics
NPI:1629366943
Name:MCKINNON, KAMILAH (PHARMD)
Entity Type:Individual
Prefix:
First Name:KAMILAH
Middle Name:
Last Name:MCKINNON
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 1:10620 RICHSMITH LN
Mailing Address - Street 2:APT. 220
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72113-9236
Mailing Address - Country:US
Mailing Address - Phone:928-225-7591
Mailing Address - Fax:
Practice Address - Street 1:10620 RICHSMITH LN
Practice Address - Street 2:APT. 220
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72113-9236
Practice Address - Country:US
Practice Address - Phone:928-225-7591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2015-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MSE12642183500000X
TN37972183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program