Provider Demographics
NPI:1306269253
Name:NIELSEN, KYLE (RPH)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:NIELSEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6783 NE VININGS WAY
Mailing Address - Street 2:APARTMENT 1123
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124
Mailing Address - Country:US
Mailing Address - Phone:541-221-9885
Mailing Address - Fax:
Practice Address - Street 1:6783 NE VININGS WAY
Practice Address - Street 2:APARTMENT 1123
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-7814
Practice Address - Country:US
Practice Address - Phone:541-221-9885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0013908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist