Provider Demographics
NPI:1558747667
Name:ANNEN, KYLIE ELIZABETH (PHARMD)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:ELIZABETH
Last Name:ANNEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:ELIZABETH
Other - Last Name:SCHOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:905 IRONTON DR
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-5909
Mailing Address - Country:US
Mailing Address - Phone:972-834-5609
Mailing Address - Fax:
Practice Address - Street 1:7302 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-1423
Practice Address - Country:US
Practice Address - Phone:806-748-6456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56858183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist