Provider Demographics
NPI:1417568510
Name:MCLAURIN, TYLER CLARK
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:CLARK
Last Name:MCLAURIN
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 1:834 BARNES CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-0909
Mailing Address - Country:US
Mailing Address - Phone:662-840-8462
Mailing Address - Fax:
Practice Address - Street 1:834 BARNES CROSSING RD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-0909
Practice Address - Country:US
Practice Address - Phone:662-840-8462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-15004183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist