MEDICARE: SHANNON MARIE KYLE

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	016210	KY
2	183500000X	Pharmacist	26024768A	IN

General Provider Information

NPI Number	:	1619235363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON MARIE KYLE

Provider Business Mailing Address
First Line	:	1523 LOU GENE AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40216-5421
Country	:	US
Telephone Number	:	502-554-8573
Fax Number	:

Provider Business Practice Location Address
First Line	:	1523 LOU GENE AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40216-5421
Country	:	US
Telephone Number	:	502-554-8573
Fax Number	:

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

Provider Enumeration Date	:	05/01/2012
Last Update Date	:	07/02/2015

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Directions to “ SHANNON MARIE KYLE ” Practice Location

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