Provider Demographics
NPI:1740958842
Name:BATCHELOR, TYLER
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:BATCHELOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20075 STATE HIGHWAY 25
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63825-8224
Mailing Address - Country:US
Mailing Address - Phone:573-625-2383
Mailing Address - Fax:
Practice Address - Street 1:1300 1ST ST
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-2526
Practice Address - Country:US
Practice Address - Phone:573-888-8880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019032438183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist