Provider Demographics
NPI:1902095698
Name:TYREE, CHELSEA DESHANNON (PHARM D)
Entity Type:Individual
Prefix:MISS
First Name:CHELSEA
Middle Name:DESHANNON
Last Name:TYREE
Suffix:
Gender:F
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 1:701 VALLEY COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40272-2796
Mailing Address - Country:US
Mailing Address - Phone:502-933-3766
Mailing Address - Fax:502-935-6857
Practice Address - Street 1:701 VALLEY COLLEGE DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40272-2796
Practice Address - Country:US
Practice Address - Phone:502-933-3766
Practice Address - Fax:502-935-6857
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011931183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist