Provider Demographics
NPI:1902113947
Name:DEVLIN, KYLE MATTHEW (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:MATTHEW
Last Name:DEVLIN
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 1:3311 DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-5222
Mailing Address - Country:US
Mailing Address - Phone:252-638-2600
Mailing Address - Fax:252-638-1182
Practice Address - Street 1:3311 DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5222
Practice Address - Country:US
Practice Address - Phone:252-638-2600
Practice Address - Fax:252-638-1182
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20570183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0255372Medicaid