MEDICARE: DR. TYLER S BEVERIDGE 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
1	183500000X	Pharmacist	PH60583539	WA

General Provider Information

NPI Number	:	1669849949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TYLER S BEVERIDGE PHARMD

Provider Business Mailing Address
First Line	:	6563 MCDONALD AVE
Second Line	:	APT 300
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-1395
Country	:	US
Telephone Number	:	801-678-3937
Fax Number	:

Provider Business Practice Location Address
First Line	:	4818 POINT FOSDICK DR NW
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-1711
Country	:	US
Telephone Number	:	235-851-6939
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2015
Last Update Date	:	08/21/2015

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