Healthcare Provider Details

I. General information

NPI: 1376229690
Provider Name (Legal Business Name): TYLER GOEGELINE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2534 BROAD ST
CAMDEN SC
29020-2238
US

IV. Provider business mailing address

333 ORISTO RIDGE WAY
WEST COLUMBIA SC
29170-6301
US

V. Phone/Fax

Practice location:
  • Phone: 803-425-8378
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number43922
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: