=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730783101
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TIMOTHY RYAN OVERPECK PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/25/2020
-----------------------------------------------------
Last Update Date | 11/25/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 820 W OHIO ST
-----------------------------------------------------
City | ROCKVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47872-1532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-569-2313
-----------------------------------------------------
Fax | 765-569-5317
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 820 W OHIO ST
-----------------------------------------------------
City | ROCKVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47872-1532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-569-2313
-----------------------------------------------------
Fax | 765-569-5317
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 26023167A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------