Provider Demographics
NPI:1407451131
Name:TYLER-HASHEMI, NICHOLAS R (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:R
Last Name:TYLER-HASHEMI
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:NICHOLAS
Other - Middle Name:
Other - Last Name:TYLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1327
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:WA
Mailing Address - Zip Code:98356-1327
Mailing Address - Country:US
Mailing Address - Phone:912-247-5335
Mailing Address - Fax:
Practice Address - Street 1:521 ADAMS AVE
Practice Address - Street 2:PHARMACY
Practice Address - City:MORTON
Practice Address - State:WA
Practice Address - Zip Code:98356
Practice Address - Country:US
Practice Address - Phone:360-496-3744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD151323336C0003X
WAPH61351583183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy