Provider Demographics
NPI:1033005962
Name:GAW, KYLE BRYAN L (PHARMD)
Entity type:Individual
Prefix:MR
First Name:KYLE BRYAN
Middle Name:L
Last Name:GAW
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:MR
Other - First Name:KYLE
Other - Middle Name:L
Other - Last Name:GAW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:PO BOX 4065
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-4065
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 4065
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92863-4065
Practice Address - Country:US
Practice Address - Phone:714-798-4485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA893111835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist