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General NPI Number Information
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NPI Number | 1174078828
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Entity Type | Individual
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Provider Name | TYLER CAHOON
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Gender | Male
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Dates
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Enumeration Date | 08/23/2016
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Last Update Date | 08/23/2016
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Provider Practice Location Address
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Address Line | 2912 MAIN ST
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City | WALKERTOWN
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State | NC
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Zip | 27051-9324
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Country | US
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Telephone | 336-595-2638
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Fax |
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Provider Business Mailing Address
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Address Line | 2028 BROMLEY PARK CT
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City | WINSTON SALEM
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State | NC
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Zip | 27103-4930
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Country | US
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Telephone | 252-671-2250
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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 | 26324
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License Number State | NC
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