Provider Demographics
NPI:1952702847
Name:THORNER, KYLE (PHARMD, BCCP)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:THORNER
Suffix:
Gender:M
Credentials:PHARMD, BCCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17325 SNUG HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-8631
Mailing Address - Country:US
Mailing Address - Phone:305-753-4718
Mailing Address - Fax:
Practice Address - Street 1:5576 GREENVILLE HWY
Practice Address - Street 2:
Practice Address - City:ZIRCONIA
Practice Address - State:NC
Practice Address - Zip Code:28790-4000
Practice Address - Country:US
Practice Address - Phone:866-849-0692
Practice Address - Fax:888-973-8821
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-4950183500000X
TN47016183500000X
IL051298021183500000X
OH3442693183500000X
FLPS55082183500000X
NC25503183500000X
AL23291183500000X
SC43802183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist