Healthcare Provider Details

I. General information

NPI: 1740887389
Provider Name (Legal Business Name): KYLE ABERNATHY PHARMACY TECHNICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2020
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2035 COMMERCE DR N
PEACHTREE CITY GA
30269-3538
US

IV. Provider business mailing address

2035 COMMERCE DR N
PEACHTREE CITY GA
30269-3538
US

V. Phone/Fax

Practice location:
  • Phone: 678-271-3970
  • Fax:
Mailing address:
  • Phone: 678-271-3970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPHTC084013
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: