NPIMap

Individual provider Active NPI

Tyler Davis, PHARMD, RPH

  • Pharmacist
  • Morgantown, WV
National Provider Identifier
1376105221
Registry record updated Jul 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
RP0011744 Issued in WV
Practice address
500 Suncrest Town Centre Dr
Morgantown, WV 26505-1820
Phone
(304) 285-6781
NPI assigned
Jul 1, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X RP0011744 WV Primary

Addresses

Primary practice location

500 Suncrest Town Centre Dr
Morgantown, WV 26505-1820

Mailing address

3292 University Ave Apt 605
Morgantown, WV 26505-2279
Phone (419) 262-5225

Other practice location 1

350 Patteson Dr
Morgantown, WV 26505-3232
Phone (304) 599-8316

Other practice location 2

1851 Earl L Core Rd
Morgantown, WV 26505
Phone (304) 296-0657

Other practice location 3

198 Emily Dr
Clarksburg, WV 26301-5501
Phone (304) 623-1482

Other practice location 4

788 W Pike St
Clarksburg, WV 26301-2649
Phone (304) 623-2598

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, Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
RP0011744WVMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Kroger Limited Partnership I Past Accepting new patients
Kroger Limited Partnership I Past Accepting new patients
Kroger Limited Partnership I Past Accepting new patients
Kroger Limited Partnership I Past Accepting new patients
Kroger Limited Partnership I Past Accepting new patients

Organizations & group practices 5

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": "1561939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561939200000",
    "number": "1376105221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3292 UNIVERSITY AVE APT 605",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265052279",
            "telephone_number": "419-262-5225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 SUNCREST TOWN CENTRE DR",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265051820",
            "telephone_number": "304-285-6781"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "350 Patteson Dr",
            "address_purpose": "LOCATION",
            "city": "Morgantown",
            "state": "WV",
            "postal_code": "265053232",
            "country_code": "US",
            "telephone_number": "304-599-8316",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1851 Earl L Core Rd",
            "address_purpose": "LOCATION",
            "city": "Morgantown",
            "state": "WV",
            "postal_code": "26505",
            "country_code": "US",
            "telephone_number": "304-296-0657",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "198 Emily Dr",
            "address_purpose": "LOCATION",
            "city": "Clarksburg",
            "state": "WV",
            "postal_code": "263015501",
            "country_code": "US",
            "telephone_number": "304-623-1482",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "788 W Pike St",
            "address_purpose": "LOCATION",
            "city": "Clarksburg",
            "state": "WV",
            "postal_code": "263012649",
            "country_code": "US",
            "telephone_number": "304-623-2598",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "TYLER",
        "credential": "PHARMD, RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-01",
        "last_updated": "2019-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WV",
            "license": "RP0011744",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Morgantown, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2019; 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.