=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558747667
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KYLIE ELIZABETH ANNEN PHARM.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2015
-----------------------------------------------------
Last Update Date | 07/31/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7302 UNIVERSITY AVE
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79423-1423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-748-6456
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 905 IRONTON DR
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79416-5909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-834-5609
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 56858
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------