Provider Demographics
NPI:1831888098
Name:GIPSON, TYLER ANN (PHARMD)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:ANN
Last Name:GIPSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:TYLER
Other - Middle Name:GIPSON
Other - Last Name:FOWLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1110 MILL RUN RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-3521
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:115 MEDICAL CIR STE 106B
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-9004
Practice Address - Country:US
Practice Address - Phone:903-877-5067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX649061835X0200X, 1835P0018X, 183500000X, 1835C0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835X0200XPharmacy Service ProvidersPharmacistOncology
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835C0207XPharmacy Service ProvidersPharmacistCompounded Sterile Preparations