1407451131 NPI number — DR. NICHOLAS R TYLER-HASHEMI PHARM D.

Table of content: DR. NICHOLAS R TYLER-HASHEMI PHARM D. (NPI 1407451131)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407451131 NPI number — DR. NICHOLAS R TYLER-HASHEMI PHARM D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TYLER-HASHEMI
Provider First Name:
NICHOLAS
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TYLER
Provider Other First Name:
NICHOLAS
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1407451131
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1327
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98356-1327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-247-5335
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
521 ADAMS AVE
Provider Second Line Business Practice Location Address:
PHARMACY
Provider Business Practice Location Address City Name:
MORTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-496-3744
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/01/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PD15132 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: PH61351583 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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