Provider Demographics
NPI:1851678833
Name:MAHAFFEY, JOSEPH KYLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:KYLE
Last Name:MAHAFFEY
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 1:8309 FRONT GATE CIR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-9507
Mailing Address - Country:US
Mailing Address - Phone:423-605-9690
Mailing Address - Fax:
Practice Address - Street 1:35 25TH ST NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3830
Practice Address - Country:US
Practice Address - Phone:423-614-4810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000033565183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist