MEDICARE: KYLE CHRISTOPHER

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	I13244	KY
2	183500000X	Pharmacist	I066708	NY

General Provider Information

NPI Number	:	1548785959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE CHRISTOPHER

Provider Business Mailing Address
First Line	:	517 N GREEN ST
Second Line	:
City	:	HENDERSON
State	:	KY
Zip	:	42420-2947
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3465 NORTH DR
Second Line	:
City	:	WELLSVILLE
State	:	NY
Zip	:	14895-9738
Country	:	US
Telephone Number	:	716-790-0358
Fax Number	:

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

Provider Enumeration Date	:	08/07/2017
Last Update Date	:	10/26/2022

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Directions to “ KYLE CHRISTOPHER ” Practice Location

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