Provider Demographics
NPI:1669063996
Name:LANDRETH, KYLEE SHAE (PHARMD)
Entity type:Individual
Prefix:
First Name:KYLEE
Middle Name:SHAE
Last Name:LANDRETH
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 1:101 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HILL CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67642-1921
Mailing Address - Country:US
Mailing Address - Phone:785-421-5632
Mailing Address - Fax:785-421-5504
Practice Address - Street 1:101 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HILL CITY
Practice Address - State:KS
Practice Address - Zip Code:67642-1921
Practice Address - Country:US
Practice Address - Phone:785-421-5632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-29
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS109266183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist