Healthcare Provider Details

I. General information

NPI: 1194439752
Provider Name (Legal Business Name): TYLER SCOTT GREEN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 W BROAD ST
GALLOWAY OH
43119-9531
US

IV. Provider business mailing address

5800 W BROAD ST
GALLOWAY OH
43119-9531
US

V. Phone/Fax

Practice location:
  • Phone: 614-870-4354
  • Fax:
Mailing address:
  • Phone: 614-870-4354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03442647
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: