Provider Demographics
NPI:1104925825
Name:MILAM, KIRK EUGENE (PHARM D)
Entity type:Individual
Prefix:MR
First Name:KIRK
Middle Name:EUGENE
Last Name:MILAM
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 NW LASALLE DR
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-4465
Mailing Address - Country:US
Mailing Address - Phone:479-271-9007
Mailing Address - Fax:
Practice Address - Street 1:316 NW LASALLE DR
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-4465
Practice Address - Country:US
Practice Address - Phone:479-271-9007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR08315183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist