Provider Demographics
NPI:1083217814
Name:TYLER, VICTORIA
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:
Last Name:TYLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 E HITESBURG RD
Mailing Address - Street 2:
Mailing Address - City:VIRGILINA
Mailing Address - State:VA
Mailing Address - Zip Code:24598-3317
Mailing Address - Country:US
Mailing Address - Phone:434-572-7848
Mailing Address - Fax:
Practice Address - Street 1:24 GATEWAY LN
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23927-3029
Practice Address - Country:US
Practice Address - Phone:434-374-8728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202011541183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist