Provider Demographics
NPI:1629734306
Name:DAYRIT, JOSHUA KYLE
Entity Type:Individual
Prefix:
First Name:JOSHUA KYLE
Middle Name:
Last Name:DAYRIT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7675 PALMILLA DR APT 6115
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-5091
Mailing Address - Country:US
Mailing Address - Phone:925-978-7917
Mailing Address - Fax:
Practice Address - Street 1:9305 MISSION GORGE RD
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-3815
Practice Address - Country:US
Practice Address - Phone:619-258-8011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85515183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist