Provider Demographics
NPI:1245831858
Name:MCMULLIN, KIRBI CHASE (PHARMD)
Entity type:Individual
Prefix:
First Name:KIRBI
Middle Name:CHASE
Last Name:MCMULLIN
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 1:1240 ALEX ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-5839
Mailing Address - Country:US
Mailing Address - Phone:870-307-2926
Mailing Address - Fax:
Practice Address - Street 1:1966 HIGHWAY 65 S
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031-6796
Practice Address - Country:US
Practice Address - Phone:501-745-2888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD13692183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist