Provider Demographics
NPI:1619557212
Name:COLE, KYLE INEZ
Entity Type:Individual
Prefix:MRS
First Name:KYLE
Middle Name:INEZ
Last Name:COLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9652 PIPER LAKE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-6830
Mailing Address - Country:US
Mailing Address - Phone:317-373-5792
Mailing Address - Fax:
Practice Address - Street 1:9652 PIPER LAKE DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46239-6830
Practice Address - Country:US
Practice Address - Phone:317-373-5792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN67006838A183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician