Healthcare Provider Details

I. General information

NPI: 1194646398
Provider Name (Legal Business Name): TYLER AHRENS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 S VETERANS PKWY
BLOOMINGTON IL
61704-7117
US

IV. Provider business mailing address

2000 N LINDEN ST APT H207
NORMAL IL
61761-5342
US

V. Phone/Fax

Practice location:
  • Phone: 309-661-1839
  • Fax: 309-661-8160
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051309024
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: