Provider Demographics
NPI:1699311621
Name:HERNDON, KYLE ANDREW (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:ANDREW
Last Name:HERNDON
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 1:5 BOONE VLG
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-1231
Mailing Address - Country:US
Mailing Address - Phone:317-873-8194
Mailing Address - Fax:317-873-5214
Practice Address - Street 1:5 BOONE VLG
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-1231
Practice Address - Country:US
Practice Address - Phone:317-873-8194
Practice Address - Fax:317-873-5214
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2020-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26026287A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist