Individual provider Active NPI

Tyler J Stevenson, PHARMD

  • Pharmacist
  • Tomahawk, WI
National Provider Identifier
1972875789
Registry record updated Feb 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
17072-40 Issued in WI
Practice address
315 W Wisconsin Ave
Tomahawk, WI 54487-1133
Phone
(715) 453-6600
Fax
(715) 453-6601
NPI assigned
Feb 9, 2012
Last updated
Feb 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 17072-40 WI Primary

Addresses

Primary practice location

315 W Wisconsin Ave
Tomahawk, WI 54487-1133

Mailing address

PO Box 429
Tomahawk, WI 54487-0429
Phone (715) 453-6600

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

LicenseStateTypeSpecialty
17072-40WIMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Tomahawk Pharmacy LLC CurrentSince Jul 25, 2019 Accepting new patients
Tomahawk Pharmacy LLC CurrentSince Feb 12, 2023 Accepting new patients

Locations

1208 N 4th St
Tomahawk, WI 54487

315 W Wisconsin Ave
Tomahawk, WI 54487
Phone (715) 453-6600

844 N 4th St
Tomahawk, WI 54487

Interoperability endpoints

  • Direct secure messaging: tstevenson@tomahawkpharmacy.libertysoftwaredirect.com
  • Direct secure messaging: tylerstevenson@tomahawkpharmacy.libertysoftwaredirect.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1328745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675728000000",
    "number": "1972875789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 429",
            "city": "TOMAHAWK",
            "state": "WI",
            "postal_code": "544870429",
            "telephone_number": "715-453-6600",
            "fax_number": "715-453-6601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 W WISCONSIN AVE",
            "city": "TOMAHAWK",
            "state": "WI",
            "postal_code": "544871133",
            "telephone_number": "715-453-6600",
            "fax_number": "715-453-6601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEVENSON",
        "first_name": "TYLER",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-02-09",
        "last_updated": "2023-02-07",
        "certification_date": "2023-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WI",
            "license": "17072-40",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tomahawk, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2023; 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.