Provider Demographics
NPI:1558761288
Name:REIS, KYLA (PHARMD)
Entity Type:Individual
Prefix:
First Name:KYLA
Middle Name:
Last Name:REIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E 104TH AVE
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-4306
Mailing Address - Country:US
Mailing Address - Phone:303-252-9150
Mailing Address - Fax:303-450-2573
Practice Address - Street 1:1400 E 104TH AVE
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-4306
Practice Address - Country:US
Practice Address - Phone:303-252-9150
Practice Address - Fax:303-450-2573
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20465183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist