Healthcare Provider Details

I. General information

NPI: 1689774622
Provider Name (Legal Business Name): TIMOTHY JAMES CUEVAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 HIGHWAY 11 S
PICAYUNE MS
39466-5382
US

IV. Provider business mailing address

28180 HIGHWAY 603
PERKINSTON MS
39573-3791
US

V. Phone/Fax

Practice location:
  • Phone: 601-798-4771
  • Fax: 601-798-6130
Mailing address:
  • Phone: 228-255-3828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE06914
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: