Provider Demographics
NPI:1194072199
Name:TYLER, MICHAEL M (RPH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:M
Last Name:TYLER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1644 S 1280 EAST CIR
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-2231
Mailing Address - Country:US
Mailing Address - Phone:435-673-8218
Mailing Address - Fax:
Practice Address - Street 1:1644 S 1280 EAST CIR
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2231
Practice Address - Country:US
Practice Address - Phone:435-673-8218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8001183500000X
UT266413-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist