Healthcare Provider Details

I. General information

NPI: 1336863406
Provider Name (Legal Business Name): KYLE RAYMOND REED CPHT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 10/03/2022
Certification Date: 10/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3706 DIANN MARIE RD
LOUISVILLE KY
40241-3818
US

IV. Provider business mailing address

1120 FOREST VIEW DR
LOUISVILLE KY
40219-4913
US

V. Phone/Fax

Practice location:
  • Phone: 502-326-9166
  • Fax:
Mailing address:
  • Phone: 850-716-0681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPT00348689
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: