Tyler Wade Simon

Primary specialty

PharmacistTaxonomy code 183500000X

License

58794 Issued in TX

Practice address

150 E Stacy Rd
Allen, TX 75002-8756

Phone

(469) 342-2005

NPI assigned

Nov 18, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• North Carolina CVS Pharmacy LLC

  • Pharmacy
  • Winston Salem, NC
  • NPI 1699797258
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1605657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605657600000",
    "number": "1861095176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 E STACY RD",
            "city": "ALLEN",
            "state": "TX",
            "postal_code": "750028756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 E STACY RD",
            "city": "ALLEN",
            "state": "TX",
            "postal_code": "750028756",
            "telephone_number": "469-342-2005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMON",
        "first_name": "TYLER",
        "middle_name": "WADE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-11-18",
        "last_updated": "2020-11-18",
        "certification_date": "2020-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TX",
            "license": "58794",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Allen",
            "affiliation": "N",
            "endpointDescription": "pharmacy",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "contentOtherDescription": "Allen",
            "address_1": "150 E Stacy Rd",
            "city": "Allen",
            "state": "TX",
            "country_code": "US",
            "postal_code": "750028756",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Silicon Design Studio LLC
• Silver Lake Dental
• Gordon Blake Simmons
• Pamela Anne Simmons, MA, LPC
• Blessy Simon, FNP-C
• Quiendra Rochelle Simone, RDH
• Simonite Inc.
• Simplifi Commercial Holdings LLC
• Michelle Sims
• Neha Walia Singh, D.P.M.

• Pharmacist in Allen, TX
• Providers in Allen, TX by specialty
• Pharmacist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.