MEDICARE: DENISE TIMM RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	116270	MN

General Provider Information

NPI Number	:	1558788091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE TIMM RPH

Provider Business Mailing Address
First Line	:	5630 SAINT CROIX TRL
Second Line	:	56
City	:	NORTH BRANCH
State	:	MN
Zip	:	55056-4202
Country	:	US
Telephone Number	:	651-674-9956
Fax Number	:	651-674-9907

Provider Business Practice Location Address
First Line	:	5630 SAINT CROIX TRL
Second Line	:	56
City	:	NORTH BRANCH
State	:	MN
Zip	:	55056-4202
Country	:	US
Telephone Number	:	651-674-9956
Fax Number	:	651-674-9907

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2014
Last Update Date	:	03/25/2014

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