Provider Demographics
NPI:1033972179
Name:DAVIS, TIMOTHY MILTON (PHARMD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:MILTON
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13856 S DARNELL ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-5373
Mailing Address - Country:US
Mailing Address - Phone:417-693-0683
Mailing Address - Fax:
Practice Address - Street 1:8501 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-3220
Practice Address - Country:US
Practice Address - Phone:913-894-2079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-13263183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist