Provider Demographics
NPI:1588977334
Name:HARRIS, KYLE THOMAS (PHARMD, BCGP)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:THOMAS
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PHARMD, BCGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-1101
Mailing Address - Country:US
Mailing Address - Phone:606-864-4155
Mailing Address - Fax:606-864-1135
Practice Address - Street 1:208 W 12TH ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1101
Practice Address - Country:US
Practice Address - Phone:606-864-4155
Practice Address - Fax:606-864-1135
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0149601835G0303X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric