Provider Demographics
NPI:1902190010
Name:DAVIS, TYLER CLEMONS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:CLEMONS
Last Name:DAVIS
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 1:6090 GARNERS FERRY RD STE A
Mailing Address - Street 2:TARGET 1923
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-0600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6090 GARNERS FERRY RD STE A
Practice Address - Street 2:TARGET 1923
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-0600
Practice Address - Country:US
Practice Address - Phone:803-783-3752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12982183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist