Tyler Wayne Allen, PHARMD
Individual provider Active NPI Pharmacist · Neosho, MO
NPI 1740882802 · NPPES record last updated Nov 13, 2020
Key facts
- NPI
- 1740882802
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 2016024473 (MO)
- Practice address
- 3200 Lusk Dr
Neosho, MO 64850-2028 - Phone
- (417) 451-1177
- Fax
- (417) 451-9620
- NPI assigned
- Nov 13, 2020
- 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 |
|---|---|---|---|
| 2016024473 | MO | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 2016024473 | MO | Yes |
Addresses
Primary practice location
3200 Lusk Dr
Neosho, MO 64850-2028
Mailing address
21 Chelsea LN
Bella Vista, AR 72715-6522
Phone (573) 822-3300
Other providers in Neosho, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 13, 2020. 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.