Provider Demographics
NPI:1518577311
Name:MAANUM, TYLER ALAN (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:ALAN
Last Name:MAANUM
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 S BILL MARTIN DR APT 6201
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-5148
Mailing Address - Country:US
Mailing Address - Phone:320-815-6098
Mailing Address - Fax:
Practice Address - Street 1:TON-SELLS INDIAN HOSPITAL PHARMACY HWY 86/TOPAWA ROAD
Practice Address - Street 2:
Practice Address - City:SELLS
Practice Address - State:AZ
Practice Address - Zip Code:85634-0548
Practice Address - Country:US
Practice Address - Phone:520-383-7350
Practice Address - Fax:520-383-7265
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRPH6237183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist