Individual
TYLER CALLAHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3499 E FAIRVIEW AVE, MERIDIAN, ID 83642-5848
(208) 605-3755
(208) 605-3754
Mailing address
3499 E FAIRVIEW AVE, MERIDIAN, ID 83642-5848
(208) 605-3755
(208) 605-3754
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
CT44252
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1275010357
—
ID
Enumeration date
05/31/2019
Last updated
05/31/2019
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