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General NPI Number Information
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NPI Number | 1679946057
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Entity Type | Individual
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Provider Name | KYLE CLARK PHARMD
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Gender | Female
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Dates
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Enumeration Date | 11/05/2015
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Last Update Date | 03/01/2017
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Provider Practice Location Address
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Address Line | 3780 E 15TH ST
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City | LOVELAND
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State | CO
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Zip | 80538-8766
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Country | US
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Telephone | 970-461-1975
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Fax | 970-467-4042
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Provider Business Mailing Address
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Address Line | 2747 KANSAS DR UNIT 107
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City | FORT COLLINS
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State | CO
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Zip | 80525-4858
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Country | US
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Telephone |
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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 | 0021402
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License Number State | CO
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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 | 18899
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License Number State | AL
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