MEDICARE: DAVID ANTHONY TYLAVSKY

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	RP448672	PA

General Provider Information

NPI Number	:	1710656475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID ANTHONY TYLAVSKY

Provider Business Mailing Address
First Line	:	PO BOX 364
Second Line	:
City	:	NEW ALEXANDRIA
State	:	PA
Zip	:	15670-0364
Country	:	US
Telephone Number	:	724-668-2284
Fax Number	:	724-662-7252

Provider Business Practice Location Address
First Line	:	8279 STATE ROUTE 22 STE 10
Second Line	:
City	:	NEW ALEXANDRIA
State	:	PA
Zip	:	15670-3155
Country	:	US
Telephone Number	:	724-668-2284
Fax Number	:

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

Provider Enumeration Date	:	09/07/2021
Last Update Date	:	03/10/2024

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