Healthcare Provider Details

I. General information

NPI: 1013838622
Provider Name (Legal Business Name): TYLER DUKOWITZ RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2390 WHITE BEAR AVE N
MAPLEWOOD MN
55109-2273
US

IV. Provider business mailing address

276 DAWN AVE
SHOREVIEW MN
55126-6243
US

V. Phone/Fax

Practice location:
  • Phone: 651-777-3113
  • Fax:
Mailing address:
  • Phone: 612-559-5136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number127430
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: