Provider Demographics
NPI:1144994583
Name:CLOVER, TYLER JAMES (PHARMD)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:JAMES
Last Name:CLOVER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-2121
Mailing Address - Country:US
Mailing Address - Phone:618-624-4313
Mailing Address - Fax:
Practice Address - Street 1:625 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-2121
Practice Address - Country:US
Practice Address - Phone:618-624-4313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-08
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051304105183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist