Healthcare Provider Details

I. General information

NPI: 1134488950
Provider Name (Legal Business Name): KYLE A. BANKS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2012
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 N MAIN ST
CEDARTOWN GA
30125-2358
US

IV. Provider business mailing address

730 N MAIN ST
CEDARTOWN GA
30125-2358
US

V. Phone/Fax

Practice location:
  • Phone: 770-749-5095
  • Fax: 770-749-0228
Mailing address:
  • Phone: 770-749-5095
  • Fax: 770-749-0228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH018686
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: