Healthcare Provider Details

I. General information

NPI: 1093197915
Provider Name (Legal Business Name): COLLEEN ANN TIMLIN PHARMD, BCOP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2015
Last Update Date: 06/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST DEPARTMENT OF PHARMACY, GROUND RHOADS
PHILADELPHIA PA
19104-4238
US

IV. Provider business mailing address

3400 SPRUCE ST DEPARTMENT OF PHARMACY, GROUND RHOADS
PHILADELPHIA PA
19104-4238
US

V. Phone/Fax

Practice location:
  • Phone: 267-303-6303
  • Fax: 215-349-5852
Mailing address:
  • Phone: 267-303-6303
  • Fax: 215-349-5852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP441904
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRP441904
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberRP441904
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: