Provider Demographics
NPI:1124754064
Name:GATES, TYLER ROBERT (PHARMD)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:ROBERT
Last Name:GATES
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 1:527 SUMMERLEA ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-1703
Mailing Address - Country:US
Mailing Address - Phone:814-316-5888
Mailing Address - Fax:
Practice Address - Street 1:2200 WASHINGTON PIKE
Practice Address - Street 2:
Practice Address - City:CARNEGIE
Practice Address - State:PA
Practice Address - Zip Code:15106-3750
Practice Address - Country:US
Practice Address - Phone:412-429-1649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP456863183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP456863OtherPHARMACIST LICENSE