Individual
DR. TYLER ANTHONY FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
102 W MAIN ST, WARSAW, KY 41095-9300
(859) 567-4601
Mailing address
5202 EAGLES PEAK WAY APT 204, LOUISVILLE, KY 40241-1389
(502) 744-0099
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
020737
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020737
KENTUCKY BOARD OF PHARMACY
KY
01
—
F11-171-186
KENTUCKY DRIVER'S LICENSE
KY
Enumeration date
11/01/2019
Last updated
11/01/2019
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