Basic Information
| Provider Information | |||||||||
| NPI: | 1184225500 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TYLER | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | RPH | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CASTLEBERRY | ||||||||
| OtherFirstName: | CAROL | ||||||||
| OtherMiddleName: | ANN | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 11 ALBACETE WAY | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS VILLAGE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719092776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5019841823 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3604 N HIGHWAY 7 | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS VILLAGE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719099607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013180902 | ||||||||
| FaxNumber: | 5013185299 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2020 | ||||||||
| LastUpdateDate: | 11/03/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 11/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 11235 | OK | N | Pharmacy Service Providers | Pharmacist | 183500000X | PS60320 | FL | N | Pharmacy Service Providers | Pharmacist | 183500000X | PD08658 | AR | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.