Provider Demographics
NPI:1649569815
Name:WEISEL, TYLER C (PHARMD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:C
Last Name:WEISEL
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 1:8 CHERRY RIVER PLZ
Mailing Address - Street 2:
Mailing Address - City:RICHWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26261-1371
Mailing Address - Country:US
Mailing Address - Phone:304-846-2406
Mailing Address - Fax:
Practice Address - Street 1:8 CHERRY RIVER PLZ
Practice Address - Street 2:
Practice Address - City:RICHWOOD
Practice Address - State:WV
Practice Address - Zip Code:26261-1371
Practice Address - Country:US
Practice Address - Phone:304-846-2406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0007571183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist