Provider Demographics
NPI:1144054891
Name:MALEK, TYLER MICHAEL
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:MICHAEL
Last Name:MALEK
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 1:1305 NEWMANS TRL
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-9510
Mailing Address - Country:US
Mailing Address - Phone:217-412-2176
Mailing Address - Fax:
Practice Address - Street 1:460 LONG HOLLOW PIKE
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-3496
Practice Address - Country:US
Practice Address - Phone:615-851-7180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY024583183500000X
TN48442183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist