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General NPI Number Information
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NPI Number | 1033890546
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Entity Type | Individual
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Provider Name | TIMOTHY JORDAN MARLER RPH
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Gender | Male
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Dates
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Enumeration Date | 07/27/2023
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Last Update Date | 07/27/2023
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Provider Practice Location Address
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Address Line | 1617 US HWY 98 S
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City | LAKELAND
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State | FL
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Zip | 33801
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Country | US
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Telephone | 863-400-4497
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Fax |
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Provider Business Mailing Address
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Address Line | 6612 WINTERSET GARDENS RD
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City | WINTER HAVEN
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State | FL
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Zip | 33884-3142
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Country | US
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Telephone | 863-412-1108
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS65980
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License Number State | FL
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