Tyler Lee Davis, PHARMD,
Individual provider Active NPI Pharmacist · Rock Falls, IL
NPI 1780080804 · NPPES record last updated Nov 17, 2014
Key facts
- NPI
- 1780080804
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 051297864 (IL)
- Practice address
- 1700 1St Ave
Rock Falls, IL 61071-3010 - Phone
- (815) 626-9562
- NPI assigned
- Nov 17, 2014
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|
| 051297864 | IL | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051297864 | IL | Yes |
Addresses
Primary practice location
1700 1St Ave
Rock Falls, IL 61071-3010
Mailing address
1700 1St Ave
Rock Falls, IL 61071-3010
Phone (815) 626-9562
Other providers in Rock Falls, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 17, 2014. 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.