Provider Demographics
NPI:1972277606
Name:WYTAS, KYLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:WYTAS
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 1:33 FIELDSTONE CMNS
Mailing Address - Street 2:
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084-3418
Mailing Address - Country:US
Mailing Address - Phone:860-872-0369
Mailing Address - Fax:
Practice Address - Street 1:33 FIELDSTONE CMNS
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-3418
Practice Address - Country:US
Practice Address - Phone:860-872-0369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0015590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist