Healthcare Provider Details

I. General information

NPI: 1588965974
Provider Name (Legal Business Name): MR. TIMOTHY NEIL DRISCOLL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TIM DRISCOLL R. PH.

II. Dates (important events)

Enumeration Date: 11/16/2010
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28461 SW MEADOWS LOOP
WILSONVILLE OR
97070-7703
US

IV. Provider business mailing address

16300 SE EVELYN ST
CLACKAMAS OR
97015-9515
US

V. Phone/Fax

Practice location:
  • Phone: 503-682-3117
  • Fax:
Mailing address:
  • Phone: 503-657-6272
  • Fax: 503-651-6143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0005639
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number00011081
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: