Healthcare Provider Details

I. General information

NPI: 1477860476
Provider Name (Legal Business Name): TYLER MICHAEL BINGHAM PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2010
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1189 E 700 S
ST GEORGE UT
84790-4022
US

IV. Provider business mailing address

1217 CAMPBELL ST
BAKER CITY OR
97814-2221
US

V. Phone/Fax

Practice location:
  • Phone: 435-628-2824
  • Fax: 435-656-6246
Mailing address:
  • Phone: 541-523-2138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0012389
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6312248-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: