Provider Demographics
NPI:1942896535
Name:ALLEN, TYLER JAMES (PHARMD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:JAMES
Last Name:ALLEN
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 1:1500 W RIO SALADO PKWY UNIT 11
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-3819
Mailing Address - Country:US
Mailing Address - Phone:602-377-4342
Mailing Address - Fax:
Practice Address - Street 1:76 W GUADALUPE RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-3349
Practice Address - Country:US
Practice Address - Phone:480-813-5785
Practice Address - Fax:480-813-6512
Is Sole Proprietor?:No
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS024828183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist