Provider Demographics
NPI:1881770402
Name:STANLEY, KELLY SUMNER (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:SUMNER
Last Name:STANLEY
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 1:105 CLUB CV
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-7440
Mailing Address - Country:US
Mailing Address - Phone:501-281-1394
Mailing Address - Fax:
Practice Address - Street 1:2413 W BEEBE CAPPS EXPY
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4907
Practice Address - Country:US
Practice Address - Phone:501-305-4108
Practice Address - Fax:501-305-4514
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD08218183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist