Healthcare Provider Details

I. General information

NPI: 1730143272
Provider Name (Legal Business Name): TYLER GRIMES RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2549 HWY 227
CARROLLTON KY
41008-8082
US

IV. Provider business mailing address

479 MARTIN RD
CARROLLTON KY
41008-8730
US

V. Phone/Fax

Practice location:
  • Phone: 502-732-5008
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number013723
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20399
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: