Healthcare Provider Details

I. General information

NPI: 1063735629
Provider Name (Legal Business Name): TIMOTHY JAMES LUNEAU RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2010
Last Update Date: 03/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 MAIN RD
HUNTINGTON VT
05462-9669
US

IV. Provider business mailing address

2640 MAIN RD
HUNTINGTON VT
05462-9669
US

V. Phone/Fax

Practice location:
  • Phone: 802-370-9043
  • Fax:
Mailing address:
  • Phone: 802-370-9043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3502
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: