Provider Demographics
NPI:1639771405
Name:KIRBY, KYLE TODD
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:TODD
Last Name:KIRBY
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 1:1021 S HIGHLINE PL
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57110-1000
Mailing Address - Country:US
Mailing Address - Phone:605-333-5601
Mailing Address - Fax:605-333-5611
Practice Address - Street 1:1021 S HIGHLINE PL
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57110-1000
Practice Address - Country:US
Practice Address - Phone:605-333-5601
Practice Address - Fax:605-333-5611
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD6781183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6781OtherSOUTH DAKOTA BOARD OF PHARMACY