Provider Demographics
NPI:1336665405
Name:SCARBOROUGH, TYLER DAVID (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:DAVID
Last Name:SCARBOROUGH
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 1:8234 LAKEMONT DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-5497
Mailing Address - Country:US
Mailing Address - Phone:352-317-1178
Mailing Address - Fax:
Practice Address - Street 1:84 TUSCAN WAY
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-1831
Practice Address - Country:US
Practice Address - Phone:904-940-2894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-20
Last Update Date:2017-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS56450183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist