MEDICARE: KYLE ALAN BEAL RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	26020922A	IN

General Provider Information

NPI Number	:	1548543952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE ALAN BEAL RPH

Provider Business Mailing Address
First Line	:	711 E 38TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46205-2748
Country	:	US
Telephone Number	:	317-927-9110
Fax Number	:	317-926-2246

Provider Business Practice Location Address
First Line	:	711 E 38TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46205-2748
Country	:	US
Telephone Number	:	317-927-9110
Fax Number	:	317-926-2246

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2011
Last Update Date	:	09/21/2011

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