Healthcare Provider Details

I. General information

NPI: 1538271010
Provider Name (Legal Business Name): TIMOTHY B SMITH RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NORTH 400 EAST
PANGUITCH UT
84759-0389
US

IV. Provider business mailing address

180 EAST 300 NORTH PO BOX 204
PANGUITCH UT
84759-0204
US

V. Phone/Fax

Practice location:
  • Phone: 435-676-1277
  • Fax: 435-676-2679
Mailing address:
  • Phone: 435-676-8747
  • Fax: 435-676-2679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number153942-1719
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: