MEDICARE: KYLE KING

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	51464	TX

General Provider Information

NPI Number	:	1912507617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE KING

Provider Business Mailing Address
First Line	:	6760 WESTWORTH BLVD
Second Line	:
City	:	WESTWORTH VILLAGE
State	:	TX
Zip	:	76114-4002
Country	:	US
Telephone Number	:	817-763-9820
Fax Number	:	817-793-9832

Provider Business Practice Location Address
First Line	:	6760 WESTWORTH BLVD
Second Line	:
City	:	WESTWORTH VILLAGE
State	:	TX
Zip	:	76114-4002
Country	:	US
Telephone Number	:	817-763-9820
Fax Number	:	817-793-9832

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

Provider Enumeration Date	:	10/30/2020
Last Update Date	:	10/30/2020

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Directions to “ KYLE KING ” Practice Location

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