Provider Demographics
NPI:1659508083
Name:SLOAN, KYLE JEFFREY (PHARM D)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:JEFFREY
Last Name:SLOAN
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 1:25 ACKLAND DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2787
Mailing Address - Country:US
Mailing Address - Phone:317-902-9663
Mailing Address - Fax:
Practice Address - Street 1:102 NEW MARKET
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NC
Practice Address - Zip Code:27025-1539
Practice Address - Country:US
Practice Address - Phone:336-548-7504
Practice Address - Fax:336-548-4301
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19968183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist