Provider Demographics
NPI:1548543952
Name:BEAL, KYLE ALAN (RPH)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:ALAN
Last Name:BEAL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 E 38TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-2748
Mailing Address - Country:US
Mailing Address - Phone:317-927-9110
Mailing Address - Fax:317-926-2246
Practice Address - Street 1:711 E 38TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-2748
Practice Address - Country:US
Practice Address - Phone:317-927-9110
Practice Address - Fax:317-926-2246
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020922A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist