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General NPI Number Information
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NPI Number | 1740213248
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Entity Type | Organization
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Legal Business Name | M. TIMBERLAKE INC
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 06/12/2014
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Provider Practice Location Address
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Address Line | 322 E MAIN ST
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22902-5234
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Country | US
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Telephone | 434-295-9155
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Fax | 434-295-5860
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Provider Business Mailing Address
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Address Line | PO BOX 2022
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22902-2022
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER AND CEO
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Name | JOHN PLANTZ
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Credential | RPH
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Telephone | 434-295-9155
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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 | 0201000435
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License Number State | VA
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