Provider Demographics
NPI:1700495900
Name:GIRTON, TYLER MATTHEW (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:MATTHEW
Last Name:GIRTON
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 1:174 KELLER DR
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-3174
Mailing Address - Country:US
Mailing Address - Phone:317-801-0052
Mailing Address - Fax:
Practice Address - Street 1:1233 N STATE ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-1056
Practice Address - Country:US
Practice Address - Phone:317-462-7713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26028757A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist