Provider Demographics
NPI:1225101611
Name:TYNER, RANDALL LYNN
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:LYNN
Last Name:TYNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5616 CHALKVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-2149
Mailing Address - Country:US
Mailing Address - Phone:205-856-3784
Mailing Address - Fax:205-853-3760
Practice Address - Street 1:5616 CHALKVILLE RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-2149
Practice Address - Country:US
Practice Address - Phone:205-856-3784
Practice Address - Fax:205-853-3760
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10247183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL10247OtherSTSATE LICENSE NUMBER