Healthcare Provider Details

I. General information

NPI: 1235380924
Provider Name (Legal Business Name): BYRON DOUGLAS KAHL PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 NORTH AVE
GRAND JUNCTION CO
81501-6428
US

IV. Provider business mailing address

50 RESER RD
WALLA WALLA WA
99362-8871
US

V. Phone/Fax

Practice location:
  • Phone: 970-242-0731
  • Fax:
Mailing address:
  • Phone: 970-270-5420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number19159
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19159
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: