Healthcare Provider Details

I. General information

NPI: 1154263911
Provider Name (Legal Business Name): TYLER BENNETT FRIEDA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 E CHEROKEE ST
SPRINGFIELD MO
65804-2203
US

IV. Provider business mailing address

826 E MAUPIN ST
BOLIVAR MO
65613-2112
US

V. Phone/Fax

Practice location:
  • Phone: 417-820-4986
  • Fax: 417-820-4986
Mailing address:
  • Phone: 417-844-2216
  • Fax: 417-844-2216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2021029268
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: