Provider Demographics
NPI:1720361512
Name:KILE, GORDON L (RPH)
Entity Type:Individual
Prefix:MR
First Name:GORDON
Middle Name:L
Last Name:KILE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 METCALF AVE
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2926
Mailing Address - Country:US
Mailing Address - Phone:913-341-1725
Mailing Address - Fax:913-341-4814
Practice Address - Street 1:7500 METCALF AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-2926
Practice Address - Country:US
Practice Address - Phone:913-341-1725
Practice Address - Fax:913-341-4814
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10380183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist