Provider Demographics
NPI:1912281957
Name:JUSTICE, DAVID TYLER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:TYLER
Last Name:JUSTICE
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 1:2647 BRADEN WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-8571
Mailing Address - Country:US
Mailing Address - Phone:606-623-5250
Mailing Address - Fax:
Practice Address - Street 1:1300 US HIGHWAY 127 S STE E
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4395
Practice Address - Country:US
Practice Address - Phone:502-223-3728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY015612183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist