Provider Demographics
NPI:1033445994
Name:FOX, TIMOTHY (RPH)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:
Last Name:FOX
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 S BURLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-3223
Mailing Address - Country:US
Mailing Address - Phone:360-757-5702
Mailing Address - Fax:360-757-5709
Practice Address - Street 1:1725 S BURLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-3223
Practice Address - Country:US
Practice Address - Phone:360-757-5702
Practice Address - Fax:360-757-5709
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00043638183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist