Healthcare Provider Details

I. General information

NPI: 1871005272
Provider Name (Legal Business Name): KYLE MCCORMICK PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2017
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4633 SUDER AVE
TOLEDO OH
43611-1829
US

IV. Provider business mailing address

2348 BARRINGTON DR
TOLEDO OH
43606-3151
US

V. Phone/Fax

Practice location:
  • Phone: 419-727-2650
  • Fax: 419-727-2651
Mailing address:
  • Phone: 419-727-2650
  • Fax: 419-727-2651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03334944
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: