Provider Demographics
NPI:1740591312
Name:KELLEY, CHRISTINA (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13680 REEVES RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER
Mailing Address - State:AR
Mailing Address - Zip Code:72002-9305
Mailing Address - Country:US
Mailing Address - Phone:870-246-1730
Mailing Address - Fax:
Practice Address - Street 1:414 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3714
Practice Address - Country:US
Practice Address - Phone:501-315-7700
Practice Address - Fax:501-315-0077
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD11295183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist