Active NPI
Tyler Kedis, RPH
- Pharmacist
- Las Vegas, NV
National Provider Identifier
1851028252
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 23015
- Practice address
- 4930 Blue Diamond Rd
Las Vegas, NV 89139-7604 - Phone
- (702) 260-9695
- NPI assigned
- Aug 4, 2022
- 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 | 23015 | NV | Primary |
Addresses
Primary practice location
4930 Blue Diamond Rd
Las Vegas, NV 89139-7604
Mailing address
45 Maleena Mesa St Apt 1622
Henderson, NV 89074-8145
Phone (562) 708-9156
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23015 | NV | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
4930 Blue Diamond Rd
Las Vegas, NV 89139
Phone (702) 260-9695
Organizations & group practices 2
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.
-
- Pharmacy
- Las Vegas, NV
- NPI 1841510617
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- Pharmacy
- Longview, TX
- NPI 1629956545
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1659571200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660262400000",
"number": "1851028252",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "45 MALEENA MESA ST APT 1622",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890748145",
"telephone_number": "562-708-9156"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4930 BLUE DIAMOND RD",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891397604",
"telephone_number": "702-260-9695"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEDIS",
"first_name": "TYLER",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-08-04",
"last_updated": "2022-08-12",
"certification_date": "2022-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NV",
"license": "23015",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.