Kyle V Brotherton, PHARM. D.
Individual provider Active NPI Pharmacist · Clio, MI
NPI 1669966263 · NPPES record last updated May 27, 2021
Key facts
- NPI
- 1669966263
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 5302038806 (MI)
- Practice address
- 415 W Vienna St
Clio, MI 48420-1307 - Phone
- (181) 054-7127
- Fax
- (810) 547-1542
- NPI assigned
- Jun 18, 2018
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
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 |
|---|---|---|---|
| 5302038806 | MI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Borden S Family Pharmacy LLC | Current | Accepting new patients | |
| Borden S Family Pharmacy LLC | Current | Accepting new patients |
Locations
415 W Vienna St
Clio, MI 48420
Phone (810) 547-1278
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist |
183500000X | 5302038806 | MI | Yes |
Addresses
Primary practice location
415 W Vienna St
Clio, MI 48420-1307
Mailing address
415 W Vienna St
Clio, MI 48420-1307
Phone (181) 054-7127
Other providers in Clio, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 27, 2021. 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.