Provider Demographics
NPI:1588092340
Name:BARNES, TYSON K (PHARM D)
Entity type:Individual
Prefix:
First Name:TYSON
Middle Name:K
Last Name:BARNES
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-4342
Mailing Address - Country:US
Mailing Address - Phone:801-791-1550
Mailing Address - Fax:
Practice Address - Street 1:1217 CAMPBELL ST
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-2221
Practice Address - Country:US
Practice Address - Phone:541-523-2138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-14
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0013825183500000X
UT7169440-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist