Provider Demographics
NPI:1154344018
Name:YOUNG, KYLE WAYNE (RPH)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:WAYNE
Last Name:YOUNG
Suffix:
Gender:
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6107 CHEROKEE DR
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-4004
Mailing Address - Country:US
Mailing Address - Phone:817-279-6729
Mailing Address - Fax:254-968-0364
Practice Address - Street 1:2445 NORTHWEST LOOP STE A
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-1705
Practice Address - Country:US
Practice Address - Phone:254-968-7657
Practice Address - Fax:254-968-0364
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2025-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25381183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist