Healthcare Provider Details

I. General information

NPI: 1861772774
Provider Name (Legal Business Name): TYLER J GEHLBACH PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2011
Last Update Date: 08/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 WOODLAWN RD
LINCOLN IL
62656-1406
US

IV. Provider business mailing address

603 WOODLAWN RD
LINCOLN IL
62656-1406
US

V. Phone/Fax

Practice location:
  • Phone: 217-732-1825
  • Fax: 217-732-9976
Mailing address:
  • Phone: 217-732-1825
  • Fax: 217-732-9976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.293642
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: