Provider Demographics
NPI:1336986678
Name:LOUNSBURY, TYLER DAVID
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:DAVID
Last Name:LOUNSBURY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 WHITTEN RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-6018
Mailing Address - Country:US
Mailing Address - Phone:207-622-3148
Mailing Address - Fax:
Practice Address - Street 1:29 WHITTEN RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-6018
Practice Address - Country:US
Practice Address - Phone:207-622-3148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR72098183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist