Healthcare Provider Details

I. General information

NPI: 1245832393
Provider Name (Legal Business Name): TIMOTHY HUNZIE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2020
Last Update Date: 11/13/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 E PINE ST
PINEDALE WY
82941
US

IV. Provider business mailing address

PO BOX 1504
PINEDALE WY
82941-1504
US

V. Phone/Fax

Practice location:
  • Phone: 307-367-4451
  • Fax: 307-367-6651
Mailing address:
  • Phone: 801-349-7956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3972
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: