Provider Demographics
NPI:1770181653
Name:HYLAND, KILEY JAY (PHARMD)
Entity Type:Individual
Prefix:
First Name:KILEY
Middle Name:JAY
Last Name:HYLAND
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 1:1000 18TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-1853
Mailing Address - Country:US
Mailing Address - Phone:507-434-8170
Mailing Address - Fax:507-434-8172
Practice Address - Street 1:1000 18TH AVE NW
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-1853
Practice Address - Country:US
Practice Address - Phone:507-434-8170
Practice Address - Fax:507-434-8172
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN122759183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist