Healthcare Provider Details

I. General information

NPI: 1679584643
Provider Name (Legal Business Name): TIMOTHY AARON KING RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N WESTWOOD BLVD
POPLAR BLUFF MO
63901-3318
US

IV. Provider business mailing address

1107 COUNTY ROAD 462
POPLAR BLUFF MO
63901-6327
US

V. Phone/Fax

Practice location:
  • Phone: 573-778-4672
  • Fax:
Mailing address:
  • Phone: 573-718-1683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number044883
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number044883
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: