Tyler Callahan
Individual provider Active NPI Pharmacy Technician · Meridian, ID
NPI 1154989440 · NPPES record last updated May 31, 2019
Key facts
- NPI
- 1154989440
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacy Technician 183700000X
- License
- CT44252 (ID)
- Practice address
- 3499 E Fairview Ave
Meridian, ID 83642-5848 - Phone
- (208) 605-3755
- Fax
- (208) 605-3754
- NPI assigned
- May 31, 2019
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CT44252 | ID | MD | Pharmacy Technician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy Technician | 183700000X | CT44252 | ID | Yes |
Addresses
Primary practice location
3499 E Fairview Ave
Meridian, ID 83642-5848
Mailing address
3499 E Fairview Ave
Meridian, ID 83642-5848
Phone (208) 605-3755
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275010357 | Medicaid | ID |
Other providers in Meridian, ID
- Jenna Cacchillo
- Shawn Calhoun
- Elias David Elkas Calkins
- Benjamin Call
- Cora Bailey Call
- Michael E Callender
- Gregory B Callis
- Michael Craig Callis
- Aaron Robert Calvano
- Allison L Calverley
All providers in Meridian, ID · Pharmacy Technician in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 31, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.