Provider Demographics
NPI:1700509825
Name:SUTTON, KYLE (RPH)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:SUTTON
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 1:4222 S 147TH PLZ APT 304
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-5546
Mailing Address - Country:US
Mailing Address - Phone:308-940-2919
Mailing Address - Fax:
Practice Address - Street 1:18040 R PLZ
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-1922
Practice Address - Country:US
Practice Address - Phone:402-408-2342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17625183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist