Healthcare Provider Details

I. General information

NPI: 1003369414
Provider Name (Legal Business Name): KYLE ALLEN ROBERTS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 W 3RD AVE STE A
SPOKANE WA
99201-5082
US

IV. Provider business mailing address

335 W APPLEWAY AVE
COEUR D ALENE ID
83814-9306
US

V. Phone/Fax

Practice location:
  • Phone: 509-838-0175
  • Fax: 509-838-2660
Mailing address:
  • Phone: 208-765-1254
  • Fax: 208-765-1303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60653905
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: