Provider Demographics
NPI:1366066524
Name:BAUMGART, KYLE ANTHONY (PHARMD)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:ANTHONY
Last Name:BAUMGART
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 1:411 S SCOTT BLVD
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-5509
Mailing Address - Country:US
Mailing Address - Phone:402-942-3180
Mailing Address - Fax:
Practice Address - Street 1:2821 1ST AVE SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-4806
Practice Address - Country:US
Practice Address - Phone:319-356-6306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23622183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist