Provider Demographics
NPI:1285084145
Name:TUSH, TYLER (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:TUSH
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 1:23079 NW 1500TH RD
Mailing Address - Street 2:
Mailing Address - City:GARNETT
Mailing Address - State:KS
Mailing Address - Zip Code:66032-8221
Mailing Address - Country:US
Mailing Address - Phone:785-304-2851
Mailing Address - Fax:
Practice Address - Street 1:311 N HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:PAOLA
Practice Address - State:KS
Practice Address - Zip Code:66071-1303
Practice Address - Country:US
Practice Address - Phone:913-294-3516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-100181183500000X
MO2016019832183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist