Provider Demographics
NPI:1790111045
Name:HARLOW, TYLER DEWITT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:DEWITT
Last Name:HARLOW
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:PO BOX 1685
Mailing Address - Street 2:
Mailing Address - City:KITTY HAWK
Mailing Address - State:NC
Mailing Address - Zip Code:27949-1685
Mailing Address - Country:US
Mailing Address - Phone:252-455-9025
Mailing Address - Fax:
Practice Address - Street 1:4119 BOONSBORO RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24503-2340
Practice Address - Country:US
Practice Address - Phone:434-384-3666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-18
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202213867183500000X
NC204931835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist