Provider Demographics
NPI:1154963478
Name:SCONYERS, KYLE LEE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:LEE
Last Name:SCONYERS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8297 E 123RD ST S
Mailing Address - Street 2:#C-200
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008
Mailing Address - Country:US
Mailing Address - Phone:918-839-0738
Mailing Address - Fax:
Practice Address - Street 1:100 N 32ND ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-2101
Practice Address - Country:US
Practice Address - Phone:918-687-1319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18010183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist