Tyler Jason Michael, RPH
Individual provider Active NPI Pharmacist · Shepherdstown, WV
NPI 1427613637 · NPPES record last updated May 2, 2019
Key facts
- NPI
- 1427613637
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- RP0011363 (WV)
- Practice address
- 26 Maddex Square Dr
Shepherdstown, WV 25443-4321 - Phone
- (304) 876-0505
- NPI assigned
- May 2, 2019
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RP0011363 | WV | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RP0011363 | WV | Yes |
Addresses
Primary practice location
26 Maddex Square Dr
Shepherdstown, WV 25443-4321
Mailing address
26 Maddex Square Dr
Shepherdstown, WV 25443-4321
Other providers in Shepherdstown, WV
- Kendra McKinney
- Caroline Clagett McLeod
- Shannon Leigh Medaris
- Karen Loncher Mennett
- Michael Monsma LLC
- Lisa Miles
- David Vernon Miljour
- Danielle Miller
- James Miller
- Michael Monsma
All providers in Shepherdstown, WV · Pharmacist in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 2, 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.