Provider Demographics
NPI:1891419503
Name:ALBERSON, TYLER JACOB (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:JACOB
Last Name:ALBERSON
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 1:208 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:IL
Mailing Address - Zip Code:61951-1454
Mailing Address - Country:US
Mailing Address - Phone:217-728-7216
Mailing Address - Fax:217-728-2816
Practice Address - Street 1:208 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:IL
Practice Address - Zip Code:61951-1454
Practice Address - Country:US
Practice Address - Phone:217-728-7216
Practice Address - Fax:217-728-2816
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051304422183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist