Provider Demographics
NPI:1457737041
Name:DUFAULT, KYLE JOSEPH (RPH)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:JOSEPH
Last Name:DUFAULT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 WESTFIELD ST
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-2550
Mailing Address - Country:US
Mailing Address - Phone:413-737-6523
Mailing Address - Fax:
Practice Address - Street 1:99 WESTFIELD ST
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-2550
Practice Address - Country:US
Practice Address - Phone:413-737-6523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH236073183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist