Healthcare Provider Details

I. General information

NPI: 1528981149
Provider Name (Legal Business Name): TYLER WERNER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 RIVER RD
EAST PEORIA IL
61611-2086
US

IV. Provider business mailing address

401 RIVER RD
EAST PEORIA IL
61611-2086
US

V. Phone/Fax

Practice location:
  • Phone: 309-694-0261
  • Fax:
Mailing address:
  • Phone: 309-694-0261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051308841
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: