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NPI Code Detail

MEDICARE: TIM'S PHARMACY & GIFT SHOP, LTD

MEDICARE: TIM'S PHARMACY & GIFT SHOP, LTD
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
1183500000XPharmacistCF00002080WA
23336C0004XCompounding Pharmacy
33336C0003XCommunity/Retail Pharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14910522OTHERWANCPDP
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1760475016
Entity Type Code : Organization
Provider Name (Legal Business Name) : TIM'S PHARMACY & GIFT SHOP, LTD
Provider Business Mailing Address
First Line : PO BOX 5120
Second Line :
City : YELM
State : WA
Zip : 98597-5120
Country : US
Telephone Number : 360-458-8467
Fax Number : 360-206-5157
Provider Business Practice Location Address
First Line : 106 1ST ST S
Second Line :
City : YELM
State : WA
Zip : 98597-7700
Country : US
Telephone Number : 360-458-8467
Fax Number : 360-206-5157
Authorized Official
Title or Position : OWNER
Name : JEFFREY SHANE HARRELL
Credential : PHARMD
Telephone Number : 360-458-8467
Provider Enumeration Date : 08/23/2005
Last Update Date : 11/16/2022

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1891088076 — WILLIAM ALEXANDER QUINBY PHARMD.
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