Provider Demographics
NPI:1710656475
Name:TYLAVSKY, DAVID ANTHONY
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ANTHONY
Last Name:TYLAVSKY
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:PO BOX 364
Mailing Address - Street 2:
Mailing Address - City:NEW ALEXANDRIA
Mailing Address - State:PA
Mailing Address - Zip Code:15670-0364
Mailing Address - Country:US
Mailing Address - Phone:724-668-2284
Mailing Address - Fax:724-662-7252
Practice Address - Street 1:8279 STATE ROUTE 22 STE 10
Practice Address - Street 2:
Practice Address - City:NEW ALEXANDRIA
Practice Address - State:PA
Practice Address - Zip Code:15670-3155
Practice Address - Country:US
Practice Address - Phone:724-668-2284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-07
Last Update Date:2024-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP448672183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist