Provider Demographics
NPI:1548529464
Name:HARROLD, TYLER PHILLIP (PHARMD)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:PHILLIP
Last Name:HARROLD
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 1:4401 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3513
Mailing Address - Country:US
Mailing Address - Phone:954-989-6524
Mailing Address - Fax:866-892-3432
Practice Address - Street 1:4401 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3513
Practice Address - Country:US
Practice Address - Phone:954-989-6524
Practice Address - Fax:866-892-3432
Is Sole Proprietor?:No
Enumeration Date:2012-05-12
Last Update Date:2012-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS48054183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS48054OtherFLORIDA BOARD OF PHARMACY