Healthcare Provider Details

I. General information

NPI: 1487387213
Provider Name (Legal Business Name): TYLER W LENG PHARMD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2022
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ELM ST N
ONAMIA MN
56359-7901
US

IV. Provider business mailing address

26660 DOLPHIN ST NW
ZIMMERMAN MN
55398-4012
US

V. Phone/Fax

Practice location:
  • Phone: 320-532-3154
  • Fax:
Mailing address:
  • Phone: 763-856-9455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number125647
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number125647
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number125647
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: