Provider Demographics
NPI:1710587597
Name:CASTLE, KYLE J (PHARMD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:J
Last Name:CASTLE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S TOLBERT DR
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-8276
Mailing Address - Country:US
Mailing Address - Phone:269-273-7833
Mailing Address - Fax:
Practice Address - Street 1:101 S TOLBERT DR
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-8276
Practice Address - Country:US
Practice Address - Phone:269-273-7833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302412208183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist