Active NPI
Kyle Nichols, PHARM.D
- Pharmacist
- Iberia, MO
National Provider Identifier
1245660182
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 2011021456
- Practice address
- 2322 Highway 17
Iberia, MO 65486-9115 - Phone
- (573) 793-2050
- NPI assigned
- Nov 13, 2013
- Last updated
- Nov 13, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 2011021456 | MO | Primary |
Addresses
Primary practice location
2322 Highway 17
Iberia, MO 65486-9115
Mailing address
2322 Highway 17
Iberia, MO 65486-9115
Phone (573) 792-2050
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2011021456 | MO | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medley Pharmacy Inc. | Past | Accepting new patients | |
| Medley Pharmacy Inc. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1384300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1384300800000",
"number": "1245660182",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2322 HIGHWAY 17",
"city": "IBERIA",
"state": "MO",
"postal_code": "654869115",
"telephone_number": "573-792-2050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2322 HIGHWAY 17",
"city": "IBERIA",
"state": "MO",
"postal_code": "654869115",
"telephone_number": "573-793-2050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLS",
"first_name": "KYLE",
"credential": "PHARM.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-11-13",
"last_updated": "2013-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "2011021456",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Iberia, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.