Provider Demographics
NPI:1134488950
Name:BANKS, KYLE A (RPH)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:A
Last Name:BANKS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CEDARTOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30125-2358
Mailing Address - Country:US
Mailing Address - Phone:770-749-5095
Mailing Address - Fax:770-749-0228
Practice Address - Street 1:730 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CEDARTOWN
Practice Address - State:GA
Practice Address - Zip Code:30125-2358
Practice Address - Country:US
Practice Address - Phone:770-749-5095
Practice Address - Fax:770-749-0228
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH018686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist