MEDICARE: MR. TIM WAYNE COLYER 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
1	183500000X	Pharmacist	0202009375	VA

General Provider Information

NPI Number	:	1881962496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIM WAYNE COLYER RPH

Provider Business Mailing Address
First Line	:	4881 COX RD
Second Line	:	BUILDING #1
City	:	GLEN ALLEN
State	:	VA
Zip	:	23060-6293
Country	:	US
Telephone Number	:	804-270-3784
Fax Number	:	804-270-9149

Provider Business Practice Location Address
First Line	:	4881 COX RD
Second Line	:	BUILDING #1
City	:	GLEN ALLEN
State	:	VA
Zip	:	23060-6293
Country	:	US
Telephone Number	:	804-270-3784
Fax Number	:	804-270-9149

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

Provider Enumeration Date	:	12/09/2011
Last Update Date	:	12/09/2011

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