Healthcare Provider Details

I. General information

NPI: 1154588390
Provider Name (Legal Business Name): TIMOTHY DEAN SCHWAB CPHT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E INDIAN SCHOOL RD
PHOENIX AZ
85012-1839
US

IV. Provider business mailing address

2509 N 11TH ST
PHOENIX AZ
85006-1066
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-5551
  • Fax:
Mailing address:
  • Phone: 602-330-2791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number4781
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: