MEDICARE: MRS. TAMMY P HYLAN

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
1	183500000X	Pharmacist	2002002436	MO

General Provider Information

NPI Number	:	1689957524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAMMY P HYLAN

Provider Business Mailing Address
First Line	:	1423 SCHULTE HILL DR
Second Line	:
City	:	MARYLAND HTS
State	:	MO
Zip	:	63043-2932
Country	:	US
Telephone Number	:	314-434-4224
Fax Number	:	314-434-6119

Provider Business Practice Location Address
First Line	:	12509 DORSETT RD
Second Line	:
City	:	MARYLAND HTS
State	:	MO
Zip	:	63043-3909
Country	:	US
Telephone Number	:	314-434-4224
Fax Number	:	341-424-6119

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2011
Last Update Date	:	09/01/2020

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