Provider Demographics
NPI:1922308352
Name:CLONTS, KYLE NELSON (PHARMD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:NELSON
Last Name:CLONTS
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 1:1255 W BASELINE RD STE 138
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-5821
Mailing Address - Country:US
Mailing Address - Phone:480-281-2930
Mailing Address - Fax:480-209-1660
Practice Address - Street 1:1255 W BASELINE RD STE 138
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-5821
Practice Address - Country:US
Practice Address - Phone:480-281-2930
Practice Address - Fax:480-209-1660
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16058183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist