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General NPI Number Information
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NPI Number | 1144686932
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Entity Type | Individual
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Provider Name | KYLE CHESTNAS
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Gender | Male
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Dates
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Enumeration Date | 01/08/2016
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Last Update Date | 08/16/2021
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Provider Practice Location Address
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Address Line | 40 THF BLVD
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City | CHESTERFIELD
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State | MO
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Zip | 63005-1150
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Country | US
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Telephone | 636-536-6215
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Fax |
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Provider Business Mailing Address
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Address Line | 8455 FERN AVE APT 1912
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City | SHREVEPORT
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State | LA
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Zip | 71105-5790
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Country | US
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Telephone | 314-477-2334
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 021324
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 2018015649
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License Number State | MO
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