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General NPI Number Information
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NPI Number | 1740460112
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Entity Type | Individual
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Provider Name | TIMOTHY M JEWETT PHARM.D
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Gender | Male
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Dates
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Enumeration Date | 11/13/2007
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Last Update Date | 03/17/2016
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Provider Practice Location Address
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Address Line | 315 ARSENAL ST
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City | WATERTOWN
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State | NY
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Zip | 13601-2431
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Country | US
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Telephone | 315-785-9079
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Fax |
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Provider Business Mailing Address
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Address Line | 349 MARGIE DR
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City | WARNER ROBINS
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State | GA
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Zip | 31088-8976
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Country | US
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Telephone | 478-953-5188
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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 | 047045
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License Number State | NY
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