Provider Demographics
NPI:1003229394
Name:SMITH, KYLE PATRICK (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:PATRICK
Last Name:SMITH
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 1:559 VINCENT ST.
Mailing Address - Street 2:SPACE BASE DELTA 1
Mailing Address - City:PETERSON SPACE FORCE BASE
Mailing Address - State:CO
Mailing Address - Zip Code:80914
Mailing Address - Country:US
Mailing Address - Phone:719-556-1109
Mailing Address - Fax:
Practice Address - Street 1:559 VINCENT ST.
Practice Address - Street 2:SPACE BASE DELTA 1
Practice Address - City:PETERSON SPACE FORCE BASE
Practice Address - State:CO
Practice Address - Zip Code:80914
Practice Address - Country:US
Practice Address - Phone:719-556-1109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC356501835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist