Healthcare Provider Details

I. General information

NPI: 1336209410
Provider Name (Legal Business Name): TIMOTHY SHAWN PIERCE RPH., MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 09/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3045 EAST AVE
CENTRAL SQUARE NY
13036-9502
US

IV. Provider business mailing address

14 BRODHEAD DR
CICERO NY
13039-8710
US

V. Phone/Fax

Practice location:
  • Phone: 315-676-2944
  • Fax: 315-676-2902
Mailing address:
  • Phone: 315-699-0273
  • Fax: 315-676-2902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number034227
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: