Active NPI
Tyler Wiseman, PHARMD
- Pharmacist
- Bountiful, UT
National Provider Identifier
1437426434
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 4768002-1701
- Practice address
- 515 S 500 W
Bountiful, UT 84010 - Phone
- (801) 294-9107
- NPI assigned
- Nov 19, 2011
- Sex
- Male
- Sole proprietor
- No
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 | 4768002-1701 | UT | Primary |
Addresses
Primary practice location
515 S 500 W
Bountiful, UT 84010
Mailing address
21 Acorn Drive
North Salt Lake, UT 84054
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
| License | State | Type | Specialty |
|---|---|---|---|
| 4768002-1701 | UT | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 1
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": "1321660800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321660800000",
"number": "1437426434",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21 ACORN DRIVE",
"city": "NORTH SALT LAKE",
"state": "UT",
"postal_code": "84054"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "515 S 500 W",
"city": "BOUNTIFUL",
"state": "UT",
"postal_code": "84010",
"telephone_number": "801-294-9107"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISEMAN",
"first_name": "TYLER",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-11-19",
"last_updated": "2011-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "UT",
"license": "4768002-1701",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bountiful, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.