Healthcare Provider Details

I. General information

NPI: 1578100350
Provider Name (Legal Business Name): HEATHER TYSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2019
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17447 CAREY RD
WESTFIELD IN
46074-9439
US

IV. Provider business mailing address

5692 DOE WAY
NOBLESVILLE IN
46062-6562
US

V. Phone/Fax

Practice location:
  • Phone: 317-867-3022
  • Fax: 317-867-3155
Mailing address:
  • Phone: 317-763-2726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number26022102A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: