Individual provider Active NPI

Tyler Seth Jones, PHARMD

  • Pharmacist
  • Green Bay, WI
National Provider Identifier
1205577467
Registry record updated Apr 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
21259-40 Issued in WI
Practice address
1979 Lime Kiln Rd
Green Bay, WI 54311-6219
Phone
(920) 288-0638
NPI assigned
Apr 4, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 21259-40 WI Primary

Addresses

Primary practice location

1979 Lime Kiln Rd
Green Bay, WI 54311-6219

Mailing address

1262 Garland St
Green Bay, WI 54301-2524
Phone (920) 619-6966

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
21259-40WIMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Walgreen Co CurrentSince Apr 10, 2022 Accepting new patients
Walgreen Co PastSince Apr 10, 2022 Accepting new patients

Locations

1979 Lime Kiln Rd
Green Bay, WI 54311
Phone (920) 288-0638

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1649030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649030400000",
    "number": "1205577467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1262 GARLAND ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543012524",
            "telephone_number": "920-619-6966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1979 LIME KILN RD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543116219",
            "telephone_number": "920-288-0638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JONES",
        "first_name": "TYLER",
        "middle_name": "SETH",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-04",
        "last_updated": "2022-04-04",
        "certification_date": "2022-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WI",
            "license": "21259-40",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.