Kyle Patrick Smith, PHARMD
Individual provider Active NPI Pharmacist · Peterson Space Force Base, CO
NPI 1003229394 · NPPES record last updated Jul 16, 2024
Key facts
- NPI
- 1003229394
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 35650 (SC)
- Practice address
- 559 Vincent St.
Space Base Delta 1
Peterson Space Force Base, CO 80914 - Phone
- (719) 556-1109
- NPI assigned
- Jun 4, 2014
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35650 | SC | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| 21St Medgrp-Peterson | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 35650 | SC | |
| Pharmacist | 183500000X | 35650 | SC | Yes |
Addresses
Primary practice location
559 Vincent St.
Space Base Delta 1
Peterson Space Force Base, CO 80914
Mailing address
559 Vincent St.
Space Base Delta 1
Peterson Space Force Base, CO 80914
Phone (719) 556-1109
Other providers in Peterson Space Force Base, CO
- Samantha Laurelin Fil
- Heather Smith Harvey
- Kathryn E O'Connell
- Yesenia Marie Rivera
- Heather Rybar
- Jena Sullenberger
- Kyle Warf
- Jeffrey Wentz
- Brittany Wheat
- Trae Williams
All providers in Peterson Space Force Base, CO · Pharmacist in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 16, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.