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NPI Code Detail

MEDICARE: MR. TYREL R VYLASEK RPH

MEDICARE: MR. TYREL R VYLASEK RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist18787MT

General Provider Information

NPI Number : 1053746354
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TYREL R VYLASEK RPH
Provider Business Mailing Address
First Line : 2301 10TH AVE S
Second Line :
City : GREAT FALLS
State : MT
Zip : 59405-2967
Country : US
Telephone Number : 406-727-1376
Fax Number : 406-727-2964
Provider Business Practice Location Address
First Line : 2301 10TH AVE S
Second Line :
City : GREAT FALLS
State : MT
Zip : 59405-2967
Country : US
Telephone Number : 406-727-1376
Fax Number : 406-727-2964
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2013
Last Update Date : 09/05/2013

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