Provider Demographics
NPI:1700335676
Name:WILLIAMS, TYLER (PHARMD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:WILLIAMS
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 1:320 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY FALLS
Mailing Address - State:KS
Mailing Address - Zip Code:66088-1302
Mailing Address - Country:US
Mailing Address - Phone:785-945-3711
Mailing Address - Fax:785-945-6156
Practice Address - Street 1:320 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:VALLEY FALLS
Practice Address - State:KS
Practice Address - Zip Code:66088-1302
Practice Address - Country:US
Practice Address - Phone:785-945-3711
Practice Address - Fax:785-945-6156
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-15309183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist