Provider Demographics
NPI:1962007328
Name:PITCHFORD, TYLER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:PITCHFORD
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 1:1900 CLUB MANOR DR STE 101
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-7443
Mailing Address - Country:US
Mailing Address - Phone:501-274-1130
Mailing Address - Fax:
Practice Address - Street 1:1900 CLUB MANOR DR STE 101
Practice Address - Street 2:
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113-7443
Practice Address - Country:US
Practice Address - Phone:501-274-1130
Practice Address - Fax:501-274-1131
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD11988183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist