Healthcare Provider Details

I. General information

NPI: 1740460112
Provider Name (Legal Business Name): TIMOTHY M JEWETT PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 ARSENAL ST
WATERTOWN NY
13601-2431
US

IV. Provider business mailing address

349 MARGIE DR
WARNER ROBINS GA
31088-8976
US

V. Phone/Fax

Practice location:
  • Phone: 315-785-9079
  • Fax:
Mailing address:
  • Phone: 478-953-5188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number047045
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: