Healthcare Provider Details

I. General information

NPI: 1427028265
Provider Name (Legal Business Name): TYLER JASON VARNUM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 SPEYERS RD
SELAH WA
98942-1050
US

IV. Provider business mailing address

552 IMPERIAL DR
HANFORD CA
93230-7316
US

V. Phone/Fax

Practice location:
  • Phone: 509-698-1244
  • Fax: 509-697-2217
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00051639
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: