Provider Demographics
NPI:1851405252
Name:TYSON, ROBERT LINDSEY (R PH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LINDSEY
Last Name:TYSON
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:LINDSEY
Other - Last Name:TYSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:215 W PECAN ST
Mailing Address - Street 2:
Mailing Address - City:COLEMAN
Mailing Address - State:TX
Mailing Address - Zip Code:76834-4147
Mailing Address - Country:US
Mailing Address - Phone:325-625-4136
Mailing Address - Fax:325-625-2427
Practice Address - Street 1:215 W PECAN ST
Practice Address - Street 2:
Practice Address - City:COLEMAN
Practice Address - State:TX
Practice Address - Zip Code:76834-4147
Practice Address - Country:US
Practice Address - Phone:325-625-4136
Practice Address - Fax:325-625-2427
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16614183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist