Healthcare Provider Details

I. General information

NPI: 1306418108
Provider Name (Legal Business Name): TYLER BROUSE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 GASTON AVE
DALLAS TX
75246-2017
US

IV. Provider business mailing address

3500 GASTON AVENUE TYLER BROUSE - INPATIENT PHARMACY
DALLAS TX
75246
US

V. Phone/Fax

Practice location:
  • Phone: 214-820-2864
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number68670
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: