Provider Demographics
NPI:1417580945
Name:ANDERSON, KYLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:ANDERSON
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 1:812 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-5208
Mailing Address - Country:US
Mailing Address - Phone:319-337-4279
Mailing Address - Fax:319-337-6286
Practice Address - Street 1:812 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-5208
Practice Address - Country:US
Practice Address - Phone:319-337-4279
Practice Address - Fax:319-337-6286
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21921183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist