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NPI Code Detail

MEDICARE: ERIK TYLER CARLSON

MEDICARE: ERIK TYLER CARLSON
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
1183500000XPharmacist13223-40WI

General Provider Information

NPI Number : 1568058634
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIK TYLER CARLSON
Provider Business Mailing Address
First Line : 5185 S 9TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53221-3627
Country : US
Telephone Number : 414-486-3100
Fax Number : 800-762-9420
Provider Business Practice Location Address
First Line : 5185 S 9TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53221-3627
Country : US
Telephone Number : 414-486-3100
Fax Number : 800-762-9420
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2020
Last Update Date : 12/14/2020

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Directions to “ ERIK TYLER CARLSON ” Practice Location

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