Provider Demographics
NPI:1285045054
Name:TUMBLESTON, KYLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
Last Name:TUMBLESTON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 BAYSHORE BLVD APT 1003
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2351
Mailing Address - Country:US
Mailing Address - Phone:813-310-7692
Mailing Address - Fax:
Practice Address - Street 1:1313 S DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-5010
Practice Address - Country:US
Practice Address - Phone:813-258-9301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS50426183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist