Healthcare Provider Details

I. General information

NPI: 1801247143
Provider Name (Legal Business Name): TYLER HEWITT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 MAIN ST
CARRINGTON ND
58421-2024
US

IV. Provider business mailing address

990 MAIN ST
CARRINGTON ND
58421-2024
US

V. Phone/Fax

Practice location:
  • Phone: 701-652-2651
  • Fax: 701-652-1882
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH5864
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: