Provider Demographics
NPI:1932318664
Name:TYGART, PHILLIP A (PD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:A
Last Name:TYGART
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:AR
Mailing Address - Zip Code:72150-0217
Mailing Address - Country:US
Mailing Address - Phone:870-942-5121
Mailing Address - Fax:870-942-2592
Practice Address - Street 1:821 N ROCK ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:AR
Practice Address - Zip Code:72150-7623
Practice Address - Country:US
Practice Address - Phone:870-942-5121
Practice Address - Fax:870-942-2592
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD06008183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist