Provider Demographics
NPI:1255855326
Name:ATKINSON, TYLER RONALD (PHARMD)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:RONALD
Last Name:ATKINSON
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 1:662 PORTLAND ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-2220
Mailing Address - Country:US
Mailing Address - Phone:612-750-9625
Mailing Address - Fax:
Practice Address - Street 1:7400 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3110
Practice Address - Country:US
Practice Address - Phone:612-750-9625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25097183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty