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General NPI Number Information
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NPI Number | 1891916391
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Entity Type | Individual
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Provider Name | KYLE D MISKIN
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Gender | Male
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 500 EAST 1400 NORTH
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City | LOGAN
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State | UT
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Zip | 84341
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Country | US
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Telephone | 435-716-5148
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Fax |
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Provider Business Mailing Address
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Address Line | 245 SOUTH 370 EAST
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City | SMITHFIELD
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State | UT
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Zip | 84335
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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 | 147269-1701
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License Number State | UT
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