Provider Demographics
NPI:1861772774
Name:GEHLBACH, TYLER J (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:J
Last Name:GEHLBACH
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 1:603 WOODLAWN RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:IL
Mailing Address - Zip Code:62656-1406
Mailing Address - Country:US
Mailing Address - Phone:217-732-1825
Mailing Address - Fax:217-732-9976
Practice Address - Street 1:603 WOODLAWN RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:IL
Practice Address - Zip Code:62656-1406
Practice Address - Country:US
Practice Address - Phone:217-732-1825
Practice Address - Fax:217-732-9976
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.293642183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist