Provider Demographics
NPI:1356907729
Name:ACHOR, KALEY S (PHARMD)
Entity type:Individual
Prefix:
First Name:KALEY
Middle Name:S
Last Name:ACHOR
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 1:1900 CLUB MANOR DR STE 101
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-7443
Mailing Address - Country:US
Mailing Address - Phone:501-590-7018
Mailing Address - Fax:501-274-1131
Practice Address - Street 1:1900 CLUB MANOR DR STE 101
Practice Address - Street 2:
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113-7443
Practice Address - Country:US
Practice Address - Phone:501-274-1130
Practice Address - Fax:501-274-1131
Is Sole Proprietor?:No
Enumeration Date:2019-05-11
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD14090183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPD14090OtherPHARMACIST LICENSE