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General NPI Number Information
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NPI Number | 1700153012
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Entity Type | Individual
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Provider Name | KYLE DAGUE PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 11/30/2011
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Last Update Date | 11/30/2011
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Provider Practice Location Address
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Address Line | 494 NUTT RD
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City | PHOENIXVILLE
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State | PA
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Zip | 19460-3354
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Country | US
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Telephone | 610-933-2798
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Fax |
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Provider Business Mailing Address
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Address Line | 919 KINGS ARMS DR
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City | DOWNINGTOWN
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State | PA
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Zip | 19335-4137
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Country | US
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Telephone | 484-593-0067
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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 | RP441671
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License Number State | PA
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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 | RPI001917
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License Number State | PA
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