Provider Demographics
NPI:1184383937
Name:FASSETT, TYLER SCOTT (PHARMD)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:SCOTT
Last Name:FASSETT
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 1:169 POMEROY MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01073-9457
Mailing Address - Country:US
Mailing Address - Phone:413-426-7024
Mailing Address - Fax:
Practice Address - Street 1:228 KING ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2364
Practice Address - Country:US
Practice Address - Phone:413-584-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH240480183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist