Provider Demographics
NPI:1548380058
Name:CLEARY, KYLEE (RPH)
Entity Type:Individual
Prefix:MS
First Name:KYLEE
Middle Name:
Last Name:CLEARY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1795 W VALENCIA RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85746-6533
Mailing Address - Country:US
Mailing Address - Phone:520-639-7645
Mailing Address - Fax:
Practice Address - Street 1:1795 W VALENCIA RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85746-6533
Practice Address - Country:US
Practice Address - Phone:520-639-7645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9239183500000X
AZS025573183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist