Healthcare Provider Details

I. General information

NPI: 1265260327
Provider Name (Legal Business Name): KYLE DUALE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 RICHMOND RD
WARRENSVILLE HEIGHTS OH
44128-5757
US

IV. Provider business mailing address

5770 GREAT NORTHERN BLVD APT A2
NORTH OLMSTED OH
44070-5615
US

V. Phone/Fax

Practice location:
  • Phone: 216-765-2784
  • Fax:
Mailing address:
  • Phone: 330-419-3151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03443462
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: