Provider Demographics
NPI:1982240271
Name:THOMAS, MICHAEL KYLE (RPH, PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:KYLE
Last Name:THOMAS
Suffix:
Gender:M
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 E MICHIGAN RD
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-4058
Mailing Address - Country:US
Mailing Address - Phone:317-421-2356
Mailing Address - Fax:317-421-2357
Practice Address - Street 1:1601 E MICHIGAN RD
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-4058
Practice Address - Country:US
Practice Address - Phone:317-421-2356
Practice Address - Fax:317-421-2357
Is Sole Proprietor?:No
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020166A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist