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NPI Code Detail

MEDICARE: TIM LYN WORSHAM RPH

MEDICARE: TIM LYN WORSHAM RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist30348TX

General Provider Information

NPI Number : 1518429505
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIM LYN WORSHAM RPH
Provider Business Mailing Address
First Line : 1466 COUNTY ROAD 3405
Second Line :
City : JACKSONVILLE
State : TX
Zip : 75766-6341
Country : US
Telephone Number : 903-284-8325
Fax Number :
Provider Business Practice Location Address
First Line : 1466 COUNTY ROAD 3405
Second Line :
City : JACKSONVILLE
State : TX
Zip : 75766-6341
Country : US
Telephone Number : 903-284-8325
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2019
Last Update Date : 04/01/2019

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