Active NPI
Elizabeth Larisa Tyson, PHARMD
- Pharmacist
- San Diego, CA
National Provider Identifier
1922649409
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 40488
- Practice address
- 9610 Ridgehaven CT Ste a
San Diego, CA 92123-5603 - Phone
- (619) 543-5231
- Fax
- (619) 543-8220
- NPI assigned
- Oct 4, 2019
- Sex
- Female
- Sole proprietor
- Yes
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 | 40488 | CA | Primary |
Addresses
Primary practice location
9610 Ridgehaven CT Ste a
San Diego, CA 92123-5603
Mailing address
9610 Ridgehaven CT Ste a
San Diego, CA 92123-5603
Phone (619) 543-5231
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40488 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1570147200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1570147200000",
"number": "1922649409",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9610 RIDGEHAVEN CT STE A",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921235603",
"telephone_number": "619-543-5231",
"fax_number": "619-543-8220"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9610 RIDGEHAVEN CT STE A",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921235603",
"telephone_number": "619-543-5231",
"fax_number": "619-543-8220"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TYSON",
"first_name": "ELIZABETH",
"middle_name": "LARISA",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-10-04",
"last_updated": "2019-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "40488",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.