Provider Demographics
NPI:1245986207
Name:GEORGE, KYLE (PHARMD, MBA, RPH)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
Last Name:GEORGE
Suffix:
Gender:M
Credentials:PHARMD, MBA, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7920 GLENBROOK DR
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-9004
Mailing Address - Country:US
Mailing Address - Phone:315-663-7949
Mailing Address - Fax:
Practice Address - Street 1:9543 US-11
Practice Address - Street 2:
Practice Address - City:BREWERTON
Practice Address - State:NY
Practice Address - Zip Code:13029
Practice Address - Country:US
Practice Address - Phone:315-676-3676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-28
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069793183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist