Provider Demographics
NPI:1740960970
Name:GILBERT, TYLER RICHARD (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:RICHARD
Last Name:GILBERT
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 1:912 ASPEN GROVE ST
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-8159
Mailing Address - Country:US
Mailing Address - Phone:208-908-1270
Mailing Address - Fax:
Practice Address - Street 1:10700 W USTICK RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-5103
Practice Address - Country:US
Practice Address - Phone:208-322-7788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP10792183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist