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NPI Code Detail

MEDICARE: TYLER DEL MAXWELL PHARMD

MEDICARE:   TYLER DEL MAXWELL  PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174H00000XHealth Educator
2390200000XStudent in an Organized Health Care Education/Training Program
31835I0206XInfectious Diseases Pharmacist066123NY

General Provider Information

NPI Number : 1154985133
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYLER DEL MAXWELL PHARMD
Provider Business Mailing Address
First Line : 1510 CARROLL ST APT 3C
Second Line :
City : BROOKLYN
State : NY
Zip : 11213-4529
Country : US
Telephone Number : 209-261-4668
Fax Number :
Provider Business Practice Location Address
First Line : 450 CLARKSON AVE # ALL1-519
Second Line :
City : BROOKLYN
State : NY
Zip : 11203-2012
Country : US
Telephone Number : 718-270-4098
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2019
Last Update Date : 05/10/2023

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