Healthcare Provider Details

I. General information

NPI: 1427692425
Provider Name (Legal Business Name): TYLER ANTHONY FREDERICK PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2019
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W MAIN ST
WARSAW KY
41095-9300
US

IV. Provider business mailing address

5202 EAGLES PEAK WAY APT 204
LOUISVILLE KY
40241-1389
US

V. Phone/Fax

Practice location:
  • Phone: 859-567-4601
  • Fax:
Mailing address:
  • Phone: 502-744-0099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number020737
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: