Provider Demographics
NPI:1760873269
Name:FUNK, KYLEE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KYLEE
Middle Name:
Last Name:FUNK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4249 STINSON BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-3357
Mailing Address - Country:US
Mailing Address - Phone:815-919-3603
Mailing Address - Fax:
Practice Address - Street 1:308 HARVARD ST SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0353
Practice Address - Country:US
Practice Address - Phone:612-301-8316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN122050183500000X
MI5302038942183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist