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General NPI Number Information
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NPI Number | 1497275267
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Entity Type | Individual
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Provider Name | MISTY DAWN TYSOR RPH
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Gender | Female
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Dates
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Enumeration Date | 06/22/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 11610 MEMORIAL PKWY SW
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City | HUNTSVILLE
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State | AL
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Zip | 35803-2152
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Country | US
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Telephone | 256-880-7261
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Fax |
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Provider Business Mailing Address
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Address Line | 129 BENNETT RD
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City | EVA
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State | AL
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Zip | 35621-8703
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Country | US
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Telephone | 256-343-1731
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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 | 16148
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 13855
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License Number State | AL
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