Individual
DR. KYLE GREGORY PSILOPOULOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
1329 US HIGHWAY 395 N, GARDNERVILLE, NV 89410-5391
(775) 782-7042
Mailing address
1097 ONNONTIOGA ST, SOUTH LAKE TAHOE, CA 96150-5901
(530) 416-2627
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
19228
NV
183500000X
Pharmacist
74434
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19228
PHARMACIST STATE LICENSE
NV
01
—
74434
PHARMACIST STATE LICENSE
CA
Enumeration date
05/03/2018
Last updated
05/03/2018
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