Healthcare Provider Details

I. General information

NPI: 1659461051
Provider Name (Legal Business Name): ROWLAND HUMPHREYS TIBBOTT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KIMBALL PLZ
EBENSBURG PA
15931-1706
US

IV. Provider business mailing address

1 KIMBALL PLZ
EBENSBURG PA
15931-1706
US

V. Phone/Fax

Practice location:
  • Phone: 814-472-9390
  • Fax:
Mailing address:
  • Phone: 814-472-9390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP025296L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: