Healthcare Provider Details

I. General information

NPI: 1700767175
Provider Name (Legal Business Name): TYLER VAGLIVELO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST
LEXINGTON KY
40536-7001
US

IV. Provider business mailing address

263 FARMINGTON AVE
FARMINGTON CT
06030-0002
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5083
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1874060
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: