Provider Demographics
NPI:1043811029
Name:WINDHAUSEN, TYLER RONALD (PHARMD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:RONALD
Last Name:WINDHAUSEN
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 1:1141 BAILEY RD
Mailing Address - Street 2:
Mailing Address - City:FABIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13063-9845
Mailing Address - Country:US
Mailing Address - Phone:315-427-8951
Mailing Address - Fax:
Practice Address - Street 1:153 MAIN ST
Practice Address - Street 2:
Practice Address - City:OWEGO
Practice Address - State:NY
Practice Address - Zip Code:13827-1779
Practice Address - Country:US
Practice Address - Phone:607-687-0891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067255183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist