Healthcare Provider Details

I. General information

NPI: 1740958842
Provider Name (Legal Business Name): TYLER BATCHELOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 1ST ST
KENNETT MO
63857-2526
US

IV. Provider business mailing address

20075 STATE HIGHWAY 25
BLOOMFIELD MO
63825-8224
US

V. Phone/Fax

Practice location:
  • Phone: 573-888-8880
  • Fax:
Mailing address:
  • Phone: 573-625-2383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2019032438
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: