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General NPI Number Information
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NPI Number | 1053695650
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Entity Type | Individual
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Provider Name | LISA VICTORIA TYLER
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Gender | Female
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Dates
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Enumeration Date | 10/01/2011
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Last Update Date | 10/01/2011
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Provider Practice Location Address
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Address Line | 2505 WHITNEY AVE
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City | HAMDEN
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State | CT
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Zip | 06518-3019
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Country | US
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Telephone | 203-288-5217
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Fax |
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Provider Business Mailing Address
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Address Line | 35 CLIFFSIDE DR
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City | WALLINGFORD
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State | CT
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Zip | 06492-1923
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Country | US
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Telephone | 203-294-0297
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0008341
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License Number State | CT
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