Provider Demographics
NPI:1104416445
Name:NOURY, TYLER ANDREW (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:ANDREW
Last Name:NOURY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 SANDY BROOK RD
Mailing Address - Street 2:
Mailing Address - City:NORTH SCITUATE
Mailing Address - State:RI
Mailing Address - Zip Code:02857-2828
Mailing Address - Country:US
Mailing Address - Phone:401-529-8723
Mailing Address - Fax:
Practice Address - Street 1:135 PITMAN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5112
Practice Address - Country:US
Practice Address - Phone:401-861-4846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH239928183500000X
RIRPH06137183500000X
CTPCT.0015461183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist