Healthcare Provider Details

I. General information

NPI: 1194323519
Provider Name (Legal Business Name): TYLER BOLAND PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2020
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3255 EDEN AVE SUITE G10
CINCINNATI OH
45229
US

IV. Provider business mailing address

KOWALEWSKI HALL G10 PO BOX 670545
CINCINNATI OH
45267-0545
US

V. Phone/Fax

Practice location:
  • Phone: 513-782-8400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH-0015775
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number051303242
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number014726
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03129659
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: