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1679862627 NPI number — TYLER JAYMES NICHOLS PHARMD

NPI Number: 1679862627
Health Care Provider/Practitioner: TYLER JAYMES NICHOLS PHARMD

Information about “1679862627” NPI (TYLER JAYMES NICHOLS PHARMD) exists in 1679862627 in HTML format HTML  |  1679862627 in plain Text format TXT  |  1679862627 in PDF (Portable Document Format) PDF  |  1679862627 in an XML format XML  formats.

NPI Number : 1679862627 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1679862627",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "NICHOLS",
    "FirstName": "TYLER",
    "MiddleName": "JAYMES",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PHARMD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "NICHOLS",
    "OtherFirstName": "TYLER",
    "OtherMiddleName": "JAYMES",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "PHARMD",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "23 FAIRFIELD AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ALBANY",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "12205-3471",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "518-928-4611",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "600 NORTHERN BLVD",
    "SecondLinePracticeLocationAddress": "ALBANY MEMORIAL HOSPITAL PHARMACY",
    "PracticeLocationAddressCityName": "ALBANY",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "12204-1004",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "518-471-3141",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/30/2011",
    "LastUpdateDate": "03/30/2011",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "183500000X",
        "TaxonomyName": "Pharmacist",
        "LicenseNumber": "054863-1",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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