Provider Demographics
NPI:1417133224
Name:CAMPBELL, KYLE NEAL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:NEAL
Last Name:CAMPBELL
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 1:10403 LAKE GROVE DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-2508
Mailing Address - Country:US
Mailing Address - Phone:813-541-1658
Mailing Address - Fax:
Practice Address - Street 1:10403 LAKE GROVE DR
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-2508
Practice Address - Country:US
Practice Address - Phone:813-541-1658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43295183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist