Healthcare Provider Details

I. General information

NPI: 1184564361
Provider Name (Legal Business Name): TYLER JOHN KALISZAK PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12070 COUNTY LINE RD STE 3
MADISON AL
35756-2000
US

IV. Provider business mailing address

238 AVIAN LN
MADISON AL
35758-6860
US

V. Phone/Fax

Practice location:
  • Phone: 256-230-2631
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23779
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: