Provider Demographics
NPI:1598046062
Name:TYLER, CHRISTOPHER JASON (RPH)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JASON
Last Name:TYLER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:WETUMKA
Mailing Address - State:OK
Mailing Address - Zip Code:74883
Mailing Address - Country:US
Mailing Address - Phone:405-452-5400
Mailing Address - Fax:405-452-3379
Practice Address - Street 1:209 S MAIN
Practice Address - Street 2:
Practice Address - City:WETUMKA
Practice Address - State:OK
Practice Address - Zip Code:74883
Practice Address - Country:US
Practice Address - Phone:405-452-3151
Practice Address - Fax:405-452-3379
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11878183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist