Provider Demographics
NPI:1336863406
Name:REED, KYLE RAYMOND (CPHT)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:RAYMOND
Last Name:REED
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 FOREST VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-4913
Mailing Address - Country:US
Mailing Address - Phone:850-716-0681
Mailing Address - Fax:
Practice Address - Street 1:3706 DIANN MARIE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-3818
Practice Address - Country:US
Practice Address - Phone:502-326-9166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT00348689183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician