Provider Demographics
NPI:1639651250
Name:LIEBEGOTT, TYLER WILLIAM (PHARM D)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:WILLIAM
Last Name:LIEBEGOTT
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-6609
Mailing Address - Country:US
Mailing Address - Phone:166-611-9230
Mailing Address - Fax:716-661-9226
Practice Address - Street 1:10 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6609
Practice Address - Country:US
Practice Address - Phone:716-661-9230
Practice Address - Fax:716-661-9226
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP452566183500000X
NY069811183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist