Healthcare Provider Details

I. General information

NPI: 1043175219
Provider Name (Legal Business Name): KYLE NORMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11701 W LONE MOUNTAIN PKWY
PEORIA AZ
85383-8164
US

IV. Provider business mailing address

7811 N 99TH AVE APT 412
GLENDALE AZ
85305-2322
US

V. Phone/Fax

Practice location:
  • Phone: 480-372-2050
  • Fax:
Mailing address:
  • Phone: 623-304-7775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1835G0000X
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: