Provider Demographics
NPI:1891089041
Name:PALMATEER, KYLE JOHNSON (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:JOHNSON
Last Name:PALMATEER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 N PROMENADE PKWY
Mailing Address - Street 2:T2353
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85194-5400
Mailing Address - Country:US
Mailing Address - Phone:520-413-6972
Mailing Address - Fax:
Practice Address - Street 1:951 N PROMENADE PKWY
Practice Address - Street 2:T2353
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85194-5400
Practice Address - Country:US
Practice Address - Phone:520-413-6972
Practice Address - Fax:520-413-6982
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016167183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist