Individual
KYLE OTIS ALVIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1140 N HAIRSTON RD, STONE MOUNTAIN, GA 30083-5800
(404) 292-0484
Mailing address
1628 JACKSON WAY NW, ATLANTA, GA 30318-0654
(786) 747-5068
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
RPH035846
GA
Other
Enumeration date
09/16/2025
Last updated
09/16/2025
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