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General NPI Number Information
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NPI Number | 1356341341
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Entity Type | Organization
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Legal Business Name | TIM WASSON INCORPORATED
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Dates
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Enumeration Date | 07/31/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 612 E MAIN ST
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City | HENDERSON
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State | TX
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Zip | 75652-2617
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Country | US
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Telephone | 903-657-1593
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Fax | 903-657-8448
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Provider Business Mailing Address
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Address Line | 612 E MAIN ST
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City | HENDERSON
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State | TX
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Zip | 75652-2617
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Country | US
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Telephone | 903-657-1593
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Fax | 903-657-8448
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. TERRY TIM WASSON
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Credential | RPH
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Telephone | 903-657-1593
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 21419
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License Number State | TX
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