Tyraeia Brooke Edwards, PHARM.D

Primary specialty

PharmacistTaxonomy code 183500000X

License

53195 Issued in TX

Practice address

12600 N Beach St
Fort Worth, TX 76244-4200

Phone

(817) 562-3901

NPI assigned

Oct 21, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

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.

• Kroger Texas LP

  dba Kroger Pharmacy #034562

  • Community/Retail Pharmacy
  • Fort Worth, TX
  • NPI 1255699476
  NPD (past)
• Kroger Texas LP

  dba Kroger Pharmacy #541

  • Community/Retail Pharmacy
  • Fort Worth, TX
  • NPI 1407747439
  NPD (past)

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

{
    "created_epoch": "1603238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603238400000",
    "number": "1265031231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12600 N BEACH ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "762444200",
            "telephone_number": "817-562-3901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12600 N BEACH ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "762444200",
            "telephone_number": "817-562-3901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "TYRAEIA",
        "middle_name": "BROOKE",
        "credential": "PHARM.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-21",
        "last_updated": "2020-10-21",
        "certification_date": "2020-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "53195",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TX",
            "license": "53195",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Tyraeia.Edwards@stores.kroger.com",
            "affiliation": "N",
            "endpointDescription": "Tyraeia.Edwards@stores.kroger.com",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "12600 N Beach St",
            "city": "Fort Worth",
            "state": "TX",
            "country_code": "US",
            "postal_code": "762444200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "tyraeia.edwards@stores.kroger.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "12600 N Beach St",
            "city": "Fort Worth",
            "state": "TX",
            "country_code": "US",
            "postal_code": "762444200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ricky D Edwards, MD
• Russell Benjamin Edwards, DO
• Stephanie Heliot Edwards, PA-C
• Toby Reed Edwards, OTA
• Torrie Edwards, FNP
• Vanzanell Edwards, ADMINISTOR
• Victoria Edwards
• Dominique Ee
• Frood Eelani, DO
• Eem Enterprises, Inc. (Fort Worth Home Care Assistance)

• Pharmacist in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Pharmacist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2020; 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.