Provider Demographics
NPI:1396335337
Name:HIVELY, KYLE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
Last Name:HIVELY
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 1:3663 SOUTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-8738
Mailing Address - Country:US
Mailing Address - Phone:479-366-4168
Mailing Address - Fax:
Practice Address - Street 1:638 CALIFORNIA AVE SW
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701-4699
Practice Address - Country:US
Practice Address - Phone:870-836-1296
Practice Address - Fax:870-836-1041
Is Sole Proprietor?:No
Enumeration Date:2021-01-23
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD13679183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARC13679OtherADMINISTER IMMUNIZATIONS CERTIFICATION
660024OtherNABP
660024OtherNCPDP
ARPD13679OtherPHARMACIST LICENSE