Provider Demographics
NPI:1952684276
Name:VACHAL, TYLER J
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:J
Last Name:VACHAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-3102
Mailing Address - Country:US
Mailing Address - Phone:406-252-0096
Mailing Address - Fax:406-252-3626
Practice Address - Street 1:1330 GRAND AVE
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-3102
Practice Address - Country:US
Practice Address - Phone:406-252-0096
Practice Address - Fax:406-252-3626
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6013183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist