Provider Demographics
NPI:1871884957
Name:TYNES, DON RANDALL (RPH)
Entity type:Individual
Prefix:
First Name:DON
Middle Name:RANDALL
Last Name:TYNES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 WOODVALE CRK
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2285
Mailing Address - Country:US
Mailing Address - Phone:318-754-7756
Mailing Address - Fax:318-227-3356
Practice Address - Street 1:211 TIMBERLANE DR
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TX
Practice Address - Zip Code:75633-2230
Practice Address - Country:US
Practice Address - Phone:903-692-3987
Practice Address - Fax:318-631-3750
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14058183500000X
TX36961183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist