Provider Demographics
NPI:1164899712
Name:WINWARD, KYLIE KHRYSTINE
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:KHRYSTINE
Last Name:WINWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2573 LAND RUSH DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-9370
Mailing Address - Country:US
Mailing Address - Phone:702-353-9420
Mailing Address - Fax:
Practice Address - Street 1:1500 S BOULDER HWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-8506
Practice Address - Country:US
Practice Address - Phone:702-567-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV19066183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist