Provider Demographics
NPI:1942606678
Name:KRISELL, KAMMY MARIE (PHARMD)
Entity Type:Individual
Prefix:MISS
First Name:KAMMY
Middle Name:MARIE
Last Name:KRISELL
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 1:5328 JFK BLVD
Mailing Address - Street 2:
Mailing Address - City:N LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-6704
Mailing Address - Country:US
Mailing Address - Phone:501-246-5035
Mailing Address - Fax:501-246-5448
Practice Address - Street 1:5328 JFK BLVD
Practice Address - Street 2:
Practice Address - City:N LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-6704
Practice Address - Country:US
Practice Address - Phone:501-246-5035
Practice Address - Fax:501-246-5448
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD08462183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist