MEDICARE: DR. KYLE CARLISLE PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS54876	FL

General Provider Information

NPI Number	:	1346669710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KYLE CARLISLE PHARMD

Provider Business Mailing Address
First Line	:	18955 US HIGHWAY 441
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-6735
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18955 US HIGHWAY 441
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-6735
Country	:	US
Telephone Number	:	352-383-1272
Fax Number	:	352-383-2455

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2014
Last Update Date	:	03/17/2018

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