Provider Demographics
NPI:1821670332
Name:WEBB, KYLE
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:WEBB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3880 PARKWOOD BLVD STE 602B
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-1931
Mailing Address - Country:US
Mailing Address - Phone:469-777-4543
Mailing Address - Fax:459-777-4693
Practice Address - Street 1:3880 PARKWOOD BLVD STE 602B
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-1931
Practice Address - Country:US
Practice Address - Phone:469-777-4543
Practice Address - Fax:459-777-4693
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-23
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX337353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX33735OtherTEXAS STATE BOARD OF PHARMACY LICENSE