Provider Demographics
NPI:1760085807
Name:LIEBERUM, TYLER NATHANIEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:NATHANIEL
Last Name:LIEBERUM
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 1:801 BALTIMORE ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-4100
Mailing Address - Country:US
Mailing Address - Phone:717-633-7292
Mailing Address - Fax:
Practice Address - Street 1:801 BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-4100
Practice Address - Country:US
Practice Address - Phone:717-633-7292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP453758183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist