Provider Demographics
NPI:1922448273
Name:KELLUMS, CALLIE LAYER (PHARM D)
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:LAYER
Last Name:KELLUMS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:CALLIE
Other - Middle Name:
Other - Last Name:LAYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:1911 W PARKER RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404
Mailing Address - Country:US
Mailing Address - Phone:870-972-0852
Mailing Address - Fax:870-974-9022
Practice Address - Street 1:1911 W PARKER RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404
Practice Address - Country:US
Practice Address - Phone:870-972-0852
Practice Address - Fax:870-974-9022
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD12336183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist