Healthcare Provider Details

I. General information

NPI: 1912620634
Provider Name (Legal Business Name): TYLER PESQUEIRA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2022
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E GRANT RD
TUCSON AZ
85705-5770
US

IV. Provider business mailing address

555 E GRANT RD
TUCSON AZ
85705-5770
US

V. Phone/Fax

Practice location:
  • Phone: 520-622-1976
  • Fax:
Mailing address:
  • Phone: 520-628-9428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS026099
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: