Provider Demographics
NPI:1649870114
Name:FRAZIER, TYLER (PHARMD)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:FRAZIER
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 1:257 ROSS DR
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:KY
Mailing Address - Zip Code:40806-8325
Mailing Address - Country:US
Mailing Address - Phone:160-627-3624
Mailing Address - Fax:
Practice Address - Street 1:201 WALDON DR
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:KY
Practice Address - Zip Code:40831-2535
Practice Address - Country:US
Practice Address - Phone:606-573-9650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY021370183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist