Healthcare Provider Details

I. General information

NPI: 1760915938
Provider Name (Legal Business Name): DR. TIMOTHY PIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2017
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 COWELL BLVD
DAVIS CA
95618-6325
US

IV. Provider business mailing address

1955 COWELL BLVD
DAVIS CA
95618-6325
US

V. Phone/Fax

Practice location:
  • Phone: 530-757-4024
  • Fax: 530-757-4012
Mailing address:
  • Phone: 530-757-4024
  • Fax: 530-757-4012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH51507
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: