Healthcare Provider Details

I. General information

NPI: 1992635460
Provider Name (Legal Business Name): TIMOTHY AUSTIN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22743 HIGHWAY 12
LEXINGTON MS
39095-3118
US

IV. Provider business mailing address

PO BOX 2124
MADISON MS
39130-2124
US

V. Phone/Fax

Practice location:
  • Phone: 662-450-8018
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-13561
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: