Provider Demographics
NPI:1639779291
Name:BROCKINTON, KELLEY BROOK (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:BROOK
Last Name:BROCKINTON
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:PO BOX 8174
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72078-8174
Mailing Address - Country:US
Mailing Address - Phone:501-650-1343
Mailing Address - Fax:
Practice Address - Street 1:8801 HIGHWAY 107
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-2929
Practice Address - Country:US
Practice Address - Phone:501-833-3116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD092081835C0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835C0205XPharmacy Service ProvidersPharmacistCritical Care