Provider Demographics
NPI:1174038863
Name:CUNICO, KYLA (PHARMD)
Entity Type:Individual
Prefix:
First Name:KYLA
Middle Name:
Last Name:CUNICO
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 1:22311 MOUNTAIN HWY E
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-7529
Mailing Address - Country:US
Mailing Address - Phone:253-846-0542
Mailing Address - Fax:
Practice Address - Street 1:22311 MOUNTAIN HWY E
Practice Address - Street 2:
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-7529
Practice Address - Country:US
Practice Address - Phone:253-846-0542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60779610183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist