Provider Demographics
NPI:1851846653
Name:KILES, TYLER MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:MARIE
Last Name:KILES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 BROOKHAVEN AVE NE
Mailing Address - Street 2:APT 736
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3253
Mailing Address - Country:US
Mailing Address - Phone:817-209-4609
Mailing Address - Fax:
Practice Address - Street 1:2345 PEACHTREE RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-4147
Practice Address - Country:US
Practice Address - Phone:404-233-2101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH029415183500000X
TX59195183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist