DR. TYLER WESLEY WALLER (NPI# 1568076602) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568076602 |
| Entity Type | Individual |
| Full Name | DR. TYLER WESLEY WALLER |
| Credential | PHARMD. |
| Practice Address |
1601 Golf Course Rd Grand Rapids MN 55744-8648 |
| Mailing Address |
28791 River View Dr Grand Rapids MN 55744-5664 |
| Practice Telephone | 2189991892 |
| Mailing Telephone | 2187669406 |
| Enumeration Date | 2020-09-05 |
| Last Update Date | 2020-09-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | 120141 | MN | Pharmacy Service Providers |
| Street Address |
1601 GOLF COURSE RD |
| City | GRAND RAPIDS |
| State | MN |
| Zip Code | 55744-8648 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326023060 | Jack Victor Carlisle | Family Medicine | 1601 Golf Course Rd, Grand Rapids, MN 55744-8648 | 2005-12-14 |
| 1699397042 | Tiffany Alicia Axtman | Nurse Practitioner | 1601 Golf Course Rd, Grand Rapids, MN 55744-8648 | 2020-05-08 |
| 1710511282 | Kelly Manner | Dietitian, Registered | 1601 Golf Course Rd, Grand Rapids, MN 55744-8648 | 2020-02-24 |
| 1285273292 | Patrick James Nelson | Physician Assistant | 1601 Golf Course Rd, Grand Rapids, MN 55744-8648 | 2019-12-23 |
| 1801446943 | Natalie Jo Castle | Physician Assistant | 1601 Golf Course Rd, Grand Rapids, MN 55744-8648 | 2019-09-19 |
| 1578121356 | Fairview Pharmacy Services LLC | Non-Pharmacy Dispensing Site | 1601 Golf Course Rd, Grand Rapids, MN 55744-8648 | 2019-06-05 |
| 1487210233 | Jake Heggem | Pharmacist | 1601 Golf Course Rd, Grand Rapids, MN 55744-8648 | 2019-05-17 |
| 1902379159 | Grand Itasca Clinic and Hospital | Pharmacy | 1601 Golf Course Rd, Grand Rapids, MN 55744-8648 | 2019-01-09 |
| 1548768534 | Michelle Overbye | Nurse Practitioner | 1601 Golf Course Rd, Grand Rapids, MN 55744 | 2018-01-25 |
| 1922457969 | Angela Degrio | Obstetrics & Gynecology | 1601 Golf Course Rd, Grand Rapids, MN 55744-8648 | 2016-06-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710587696 | Friesen & Friesen, Inc | Assisted Living Facility | 1971 Ne 1st Avenue, Grand Rapids, MN 55744 | 2020-10-29 |
| 1699392555 | Duane Stanley Helmer | Counselor | First Call for Help of Itasca County, 1707 Nw 4th Street Suite B, Grand Rapids, MN 55744 | 2020-06-26 |
| 1821631391 | Patrice Marie Curtiss | Technician | 23792 Winckler Road, Grand Rapids, MN 55744 | 2019-10-28 |
| 1578117438 | Christina Marie Hubred | Advanced Practice Dental Therapist | Miskovich Dental Clinic, 1121 Se 4th Avenue, Grand Rapids, MN 55744 | 2019-07-30 |
| 1780081877 | Fcsl Grand Rapids, LLC | Assisted Living Facility | 949 1/2 Sw 11th Street, Grand Rapids, MN 55744 | 2014-12-04 |
| 1912311333 | Doctor V LLC | Psychologist | 2002 Cromell Drive, Hope House of Itasca County, Laprairie, MN 55744 | 2014-06-13 |
| 1104244987 | Linda Reinen-thompson | Contractor | 34307 Hwy. 38, Grand Rapids, MN 55744 | 2014-03-31 |
| 1275883266 | Lana Rae Jacobson | Registered Nurse | 1401 Nw 9th Street, Grand Rapids, MN 55744 | 2012-09-17 |
| 1518252048 | David Allen Griggs | Pharmacist | 2140 S.pokegama Ave., T-0904, Target, Grand Rapids, MN 55744 | 2011-06-13 |
| 1447575063 | Kelly Ann Shermoen | Pharmacist | 18 Se 10th Street, Grand Rapids, MN 55744 | 2010-04-07 |
| Find all providers in zip 55744 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164031860 | Jerika Nguyen | Pharmacist | 525 Clancy Ave Ne Apt 120, Grand Rapids, MI 49503-1843 | 2020-07-28 |
| 1063045177 | Kristen Buthker | Pharmacist | 1021 Alpine Ave Nw, Grand Rapids, MI 49504-4139 | 2020-02-17 |
| 1124667258 | Grant Lawson Beach | Pharmacist | 201 Michigan St Nw Apt 910, Grand Rapids, MI 49503-2330 | 2020-01-07 |
| 1821562844 | Catherine Formalejo Padogdog | Pharmacist | 2051 Ridgecrest Rd Se Apt 7, Grand Rapids, MI 49546-4321 | 2019-01-12 |
| 1386151660 | Brett Donald Jenkins | Pharmacist | 3326 Weatherford Dr Nw Apt 3a, Grand Rapids, MI 49544-6966 | 2018-01-08 |
| 1326568296 | Sarah Ann Kauffman | Pharmacist | 360 Division Ave S Ste 1a, Grand Rapids, MI 49503-4501 | 2017-06-22 |
| 1760920698 | Heidi Catherine Stultz-griffey | Pharmacist | 970 4 Mile Rd Nw Apt 1d, Grand Rapids, MI 49544 | 2017-02-12 |
| 1235585456 | Kirsten Hayes | Pharmacist | 510 College Ave Ne Apt 215, Grand Rapids, MI 49503-1770 | 2016-05-06 |
| 1740649201 | Robert Matthew Granett | Pharmacist | 200 Jefferson Ave Se # See, Grand Rapids, MI 49503-4502 | 2016-02-12 |
| 1386000420 | Samantha Shifman | Pharmacist | 555 7th St Nw, Apt. 208, Grand Rapids, MI 49504-5213 | 2016-01-05 |
| Find all providers in GRAND RAPIDS | ||||
| City | GRAND RAPIDS |
| Zip Code | 55744 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.