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NPI Code Detail

MEDICARE: ALICIA TYSON PHARMD

MEDICARE: ALICIA TYSON PHARMD
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
1183500000XPharmacist26044NC

General Provider Information

NPI Number : 1346692209
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALICIA TYSON PHARMD
Provider Business Mailing Address
First Line : 2718 SAINTFIELD PL
Second Line :
City : CHARLOTTE
State : NC
Zip : 28270-1313
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 112 S SHARON AMITY RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28211-2802
Country : US
Telephone Number : 704-366-5684
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2016
Last Update Date : 07/05/2016

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Directions to “ ALICIA TYSON PHARMD” Practice Location

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