MEDICARE: DR. TIMOTHY A YOUSO PHARM D

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
1	183500000X	Pharmacist	S010095	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0316934	OTHER	AZ	NABP
2	1164449377	OTHER	AZ	NPI

General Provider Information

NPI Number	:	1619356680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY A YOUSO PHARM D

Provider Business Mailing Address
First Line	:	5695 HIGHWAY 95 N
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86404-9646
Country	:	US
Telephone Number	:	928-764-3737
Fax Number	:

Provider Business Practice Location Address
First Line	:	5695 HIGHWAY 95 N
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86404-9646
Country	:	US
Telephone Number	:	928-764-3737
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2015
Last Update Date	:	03/07/2023

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