Provider Demographics
NPI:1487422127
Name:HARRIS, KYLIE FRITZE
Entity type:Individual
Prefix:DR
First Name:KYLIE
Middle Name:FRITZE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3227 W GROVERS AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-6625
Mailing Address - Country:US
Mailing Address - Phone:198-960-0848
Mailing Address - Fax:
Practice Address - Street 1:21585 N 77TH AVE # 1500
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2138
Practice Address - Country:US
Practice Address - Phone:623-362-9322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS0261061835C0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835C0207XPharmacy Service ProvidersPharmacistCompounded Sterile Preparations