Healthcare Provider Details

I. General information

NPI: 1720833957
Provider Name (Legal Business Name): KYLE JOHN MAHONEY PHARMD, MBA, BCPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S ANDREWS AVE
FORT LAUDERDALE FL
33316-2510
US

IV. Provider business mailing address

1600 S ANDREWS AVE
FORT LAUDERDALE FL
33316-2510
US

V. Phone/Fax

Practice location:
  • Phone: 954-355-4400
  • Fax:
Mailing address:
  • Phone: 954-355-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS64779
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH239651
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number3168057
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: