Provider Demographics
NPI:1730773987
Name:ASHBY, TYLER (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:ASHBY
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 1:13309 E 33RD ST
Mailing Address - Street 2:
Mailing Address - City:JONES
Mailing Address - State:OK
Mailing Address - Zip Code:73049-9715
Mailing Address - Country:US
Mailing Address - Phone:405-408-8552
Mailing Address - Fax:
Practice Address - Street 1:1117 W I 35 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-7398
Practice Address - Country:US
Practice Address - Phone:405-408-8552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13601183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist