Provider Demographics
NPI:1104252881
Name:GILLS, KELLI CUNNINGHAM (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:CUNNINGHAM
Last Name:GILLS
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 1:624 S ROCK ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:AR
Mailing Address - Zip Code:72150-7064
Mailing Address - Country:US
Mailing Address - Phone:870-942-5800
Mailing Address - Fax:870-942-5139
Practice Address - Street 1:624 S ROCK ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:AR
Practice Address - Zip Code:72150-7064
Practice Address - Country:US
Practice Address - Phone:870-942-5800
Practice Address - Fax:870-942-5139
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD09397183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist