Tyler Jordan Geerdes, PHARMD
Individual provider Active NPI Pharmacist · Cumberland, WI
NPI 1497939987 · NPPES record last updated Feb 1, 2023
Key facts
- NPI
- 1497939987
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 15899-40 (WI)
- Practice address
- 1110 7TH Ave
Cumberland, WI 54829-9138 - Phone
- (715) 822-7110
- Fax
- (715) 822-7111
- NPI assigned
- Dec 20, 2007
- 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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5755 | SD | MD | Pharmacist |
| 15899-40 | WI | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 5755 | SD | |
| Pharmacist | 183500000X | 15899-40 | WI | Yes |
Addresses
Primary practice location
1110 7TH Ave
Cumberland, WI 54829-9138
Mailing address
1987 18TH St
Rice Lake, WI 54868-8508
Phone (605) 261-9318
Other practice location 1
1987 18th St
Rice Lake, WI 54868-8508
Phone (605) 261-9318
Other providers in Cumberland, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 1, 2023. 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.