Provider Demographics
NPI:1669875035
Name:SHIPP, KARA CHARLES (PD)
Entity type:Individual
Prefix:MR
First Name:KARA
Middle Name:CHARLES
Last Name:SHIPP
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4685 SAWGRASS CV
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-5007
Mailing Address - Country:US
Mailing Address - Phone:501-327-8088
Mailing Address - Fax:
Practice Address - Street 1:2125 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-6210
Practice Address - Country:US
Practice Address - Phone:501-327-8088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD07415183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist