Provider Demographics
NPI:1346438413
Name:WESTBROOK, TYLER NICHOLE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:TYLER
Middle Name:NICHOLE
Last Name:WESTBROOK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:TYLER
Other - Middle Name:NICHOLE
Other - Last Name:SHELNUTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:414 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-3714
Mailing Address - Country:US
Mailing Address - Phone:501-315-7700
Mailing Address - Fax:
Practice Address - Street 1:414 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3714
Practice Address - Country:US
Practice Address - Phone:501-315-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-14
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD10537183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist