Provider Demographics
NPI:1013559269
Name:TIMBERLINE PHARMACY
Entity Type:Organization
Organization Name:TIMBERLINE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-828-7389
Mailing Address - Street 1:PO BOX 171145
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-1145
Mailing Address - Country:US
Mailing Address - Phone:801-828-7389
Mailing Address - Fax:
Practice Address - Street 1:4574 N TEN MILE RD STE 110
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-6930
Practice Address - Country:US
Practice Address - Phone:208-616-1722
Practice Address - Fax:208-616-1863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy