MEDICARE: DR. KYLE SALATA PHARN.D

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	RP443959	PA

General Provider Information

NPI Number	:	1811421845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KYLE SALATA PHARN.D

Provider Business Mailing Address
First Line	:	5205 MILITIA HILL RD
Second Line	:	SUITE 200
City	:	PLYMOUTH MEETING
State	:	PA
Zip	:	19462-1216
Country	:	US
Telephone Number	:	484-681-5756
Fax Number	:

Provider Business Practice Location Address
First Line	:	5205 MILITIA HILL RD
Second Line	:	SUITE 200
City	:	PLYMOUTH MEETING
State	:	PA
Zip	:	19462-1216
Country	:	US
Telephone Number	:	484-681-5756
Fax Number	:

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

Provider Enumeration Date	:	04/17/2017
Last Update Date	:	04/17/2017

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