Provider Demographics
NPI:1235485558
Name:PICKERILL, KYLE ROSS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:ROSS
Last Name:PICKERILL
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 1:228 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ORDWAY
Mailing Address - State:CO
Mailing Address - Zip Code:81063-1403
Mailing Address - Country:US
Mailing Address - Phone:719-267-3544
Mailing Address - Fax:719-267-4443
Practice Address - Street 1:228 MAIN ST
Practice Address - Street 2:
Practice Address - City:ORDWAY
Practice Address - State:CO
Practice Address - Zip Code:81063-1403
Practice Address - Country:US
Practice Address - Phone:719-267-3544
Practice Address - Fax:719-267-4443
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19475183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist