Provider Demographics
NPI:1174078828
Name:CAHOON, TYLER
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:CAHOON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2028 BROMLEY PARK CT
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4930
Mailing Address - Country:US
Mailing Address - Phone:252-671-2250
Mailing Address - Fax:
Practice Address - Street 1:2912 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALKERTOWN
Practice Address - State:NC
Practice Address - Zip Code:27051-9324
Practice Address - Country:US
Practice Address - Phone:336-595-2638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26324183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist