Provider Demographics
NPI:1598017964
Name:SPURGEON, KYLE (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:
Last Name:SPURGEON
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 1:553 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-7357
Mailing Address - Country:US
Mailing Address - Phone:317-989-4675
Mailing Address - Fax:
Practice Address - Street 1:6269 W 38TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-2928
Practice Address - Country:US
Practice Address - Phone:317-293-8640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26024696A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist