Provider Demographics
NPI:1417384041
Name:BEMIS, KYLE JEFFREY (PHARM D)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:JEFFREY
Last Name:BEMIS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 N JACKSON ST
Mailing Address - Street 2:APT, 406
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-2003
Mailing Address - Country:US
Mailing Address - Phone:920-915-3808
Mailing Address - Fax:
Practice Address - Street 1:2600 S 108TH ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-1926
Practice Address - Country:US
Practice Address - Phone:414-545-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17136-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist