Healthcare Provider Details

I. General information

NPI: 1093168502
Provider Name (Legal Business Name): KYLE THOMAS TOWNSWICK PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 1ST ST S
WILLMAR MN
56201-4212
US

IV. Provider business mailing address

5800 E EAGLE LAKE RD
WILLMAR MN
56201-4456
US

V. Phone/Fax

Practice location:
  • Phone: 320-235-1930
  • Fax: 320-235-7801
Mailing address:
  • Phone: 320-894-6779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number122958
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: