Provider Demographics
NPI:1942586219
Name:IHRY, KYLE ROSS (PHARM D)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:ROSS
Last Name:IHRY
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 1:10686 UNIVERSITY AVE NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-6141
Mailing Address - Country:US
Mailing Address - Phone:763-755-1259
Mailing Address - Fax:
Practice Address - Street 1:10686 UNIVERSITY AVE NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55448-6141
Practice Address - Country:US
Practice Address - Phone:763-755-1259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118546183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist