Healthcare Provider Details

I. General information

NPI: 1124639174
Provider Name (Legal Business Name): TYLER CALVIN DOWNEY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 CORONADO ST
IDAHO FALLS ID
83404-7407
US

IV. Provider business mailing address

3580 RED CLIFF BLVD # A
IDAHO FALLS ID
83401-1758
US

V. Phone/Fax

Practice location:
  • Phone: 208-557-2738
  • Fax:
Mailing address:
  • Phone: 307-256-4481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberP8832
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: