Healthcare Provider Details

I. General information

NPI: 1184177628
Provider Name (Legal Business Name): TYLER ROGERS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 SHEYENNE ST
WEST FARGO ND
58078-2797
US

IV. Provider business mailing address

314 OHMER ST
BOTTINEAU ND
58318-1059
US

V. Phone/Fax

Practice location:
  • Phone: 701-630-0695
  • Fax:
Mailing address:
  • Phone: 701-228-2220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH5789
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: