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General NPI Number Information
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NPI Number | 1275412751
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Entity Type | Individual
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Provider Name | WYATT KILE
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Gender | Male
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Dates
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Enumeration Date | 08/29/2025
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 1710 W 2ND ST
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City | GRAND ISLAND
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State | NE
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Zip | 68803-5409
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Country | US
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Telephone | 308-384-4089
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Fax |
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Provider Business Mailing Address
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Address Line | 4006 HUFF BLVD
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City | GRAND ISLAND
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State | NE
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Zip | 68803
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Country | US
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Telephone | 402-746-0368
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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 | 17898
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License Number State | NE
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