Provider Demographics
NPI:1255524724
Name:AUSTIN, KYLE (PHARMD)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:
Last Name:AUSTIN
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 1:38504 US HIGHWAY 2
Mailing Address - Street 2:
Mailing Address - City:HAVRE
Mailing Address - State:MT
Mailing Address - Zip Code:59501-8232
Mailing Address - Country:US
Mailing Address - Phone:406-262-3098
Mailing Address - Fax:
Practice Address - Street 1:38504 US HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:HAVRE
Practice Address - State:MT
Practice Address - Zip Code:59501-8232
Practice Address - Country:US
Practice Address - Phone:406-262-3098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-19
Last Update Date:2020-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist