Provider Demographics
NPI:1891577680
Name:JENNINGS, TYLER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:JENNINGS
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 1:1608 JIM JIM CT
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-1330
Mailing Address - Country:US
Mailing Address - Phone:941-441-7934
Mailing Address - Fax:
Practice Address - Street 1:15 S INDIANA AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-3305
Practice Address - Country:US
Practice Address - Phone:941-473-7787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS66434183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist