Provider Demographics
NPI:1720237100
Name:TYLER, DOROTHY (RPH)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:TYLER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-1704
Mailing Address - Country:US
Mailing Address - Phone:315-593-2158
Mailing Address - Fax:
Practice Address - Street 1:17 S 1ST ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-1704
Practice Address - Country:US
Practice Address - Phone:315-593-2158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038247183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist