Provider Demographics
NPI:1477860476
Name:BINGHAM, TYLER MICHAEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:MICHAEL
Last Name:BINGHAM
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 1:1217 CAMPBELL ST
Mailing Address - Street 2:
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-2221
Mailing Address - Country:US
Mailing Address - Phone:541-523-2138
Mailing Address - Fax:
Practice Address - Street 1:1189 E 700 S
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4022
Practice Address - Country:US
Practice Address - Phone:435-628-2824
Practice Address - Fax:435-656-6246
Is Sole Proprietor?:No
Enumeration Date:2010-09-12
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0012389183500000X
UT6312248-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist