Healthcare Provider Details

I. General information

NPI: 1346158565
Provider Name (Legal Business Name): TYLER CHASE SCHALLHORN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2026
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2562 NAVARRE AVE
OREGON OH
43616-3171
US

IV. Provider business mailing address

12124 RYZNAR DR
VAN BUREN TOWNSHIP MI
48111-2247
US

V. Phone/Fax

Practice location:
  • Phone: 419-693-9034
  • Fax: 419-693-9147
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302419246
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03447220
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: