Provider Demographics
NPI:1376858324
Name:WALGOS, KYRA LYNN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KYRA
Middle Name:LYNN
Last Name:WALGOS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 BELDEN PL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-7405
Mailing Address - Country:US
Mailing Address - Phone:919-880-9207
Mailing Address - Fax:
Practice Address - Street 1:2501 BELDEN PL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-7405
Practice Address - Country:US
Practice Address - Phone:919-880-9207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-15
Last Update Date:2010-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20535183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist