Healthcare Provider Details

I. General information

NPI: 1033403795
Provider Name (Legal Business Name): ROBERT GERALD KAIL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2011
Last Update Date: 05/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 HENSLEE DR
DICKSON TN
37055-2092
US

IV. Provider business mailing address

PO BOX 553
DICKSON TN
37056-0553
US

V. Phone/Fax

Practice location:
  • Phone: 615-446-5222
  • Fax:
Mailing address:
  • Phone: 731-847-2084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6774
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: