Provider Demographics
NPI:1023576667
Name:LANCASTER, TYSON DALE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TYSON
Middle Name:DALE
Last Name:LANCASTER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5278 MERRILL RD
Mailing Address - Street 2:
Mailing Address - City:LUCEDALE
Mailing Address - State:MS
Mailing Address - Zip Code:39452-5403
Mailing Address - Country:US
Mailing Address - Phone:228-623-2898
Mailing Address - Fax:
Practice Address - Street 1:5278 MERRILL RD
Practice Address - Street 2:
Practice Address - City:LUCEDALE
Practice Address - State:MS
Practice Address - Zip Code:39452-5403
Practice Address - Country:US
Practice Address - Phone:228-623-2898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-02
Last Update Date:2019-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32673183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist