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General NPI Number Information
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NPI Number | 1194265231
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Entity Type | Individual
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Provider Name | TIMOTHY ROBERT BODLE R.PH.
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Gender | Male
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Dates
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Enumeration Date | 03/07/2017
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Last Update Date | 03/07/2017
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Provider Practice Location Address
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Address Line | 11 MANSFIELD AVE
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City | SHELBY
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State | OH
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Zip | 44875-1367
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Country | US
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Telephone | 419-347-1506
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Fax |
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Provider Business Mailing Address
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Address Line | 5406 GINGER HILL RD
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City | UTICA
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State | OH
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Zip | 43080-9575
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Country | US
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Telephone | 740-973-7177
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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 | 03321685
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License Number State | OH
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