Provider Demographics
NPI:1740882802
Name:ALLEN, TYLER WAYNE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:WAYNE
Last Name:ALLEN
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 1:21 CHELSEA LN
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72715-6522
Mailing Address - Country:US
Mailing Address - Phone:573-822-3300
Mailing Address - Fax:
Practice Address - Street 1:3200 LUSK DR
Practice Address - Street 2:
Practice Address - City:NEOSHO
Practice Address - State:MO
Practice Address - Zip Code:64850-2028
Practice Address - Country:US
Practice Address - Phone:417-451-1177
Practice Address - Fax:417-451-9620
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016024473183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist