Active NPI
Tyler Edwards
- Pharmacist
- Mohegan Lake, NY
National Provider Identifier
1235842600
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 069361
- Practice address
- 1775 E Main St
Mohegan Lake, NY 10547-1356 - Phone
- (914) 528-5591
- NPI assigned
- Jan 2, 2023
- Last updated
- Jan 2, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 069361 | NY | Primary |
Addresses
Primary practice location
1775 E Main St
Mohegan Lake, NY 10547-1356
Mailing address
24 Rensselaer Dr
Spring Valley, NY 10977-1827
Phone (845) 406-5045
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 069361 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1672617600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1672617600000",
"number": "1235842600",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24 RENSSELAER DR",
"city": "SPRING VALLEY",
"state": "NY",
"postal_code": "109771827",
"telephone_number": "845-406-5045"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1775 E MAIN ST",
"city": "MOHEGAN LAKE",
"state": "NY",
"postal_code": "105471356",
"telephone_number": "914-528-5591"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDWARDS",
"first_name": "TYLER",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-01-02",
"last_updated": "2023-01-02",
"certification_date": "2022-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "069361",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mohegan Lake, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.