Provider Demographics
NPI:1073687364
Name:SHEEHAN, TIMMY JON (RPH)
Entity Type:Individual
Prefix:MR
First Name:TIMMY
Middle Name:JON
Last Name:SHEEHAN
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 1:171 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:OH
Mailing Address - Zip Code:43342
Mailing Address - Country:US
Mailing Address - Phone:740-494-2663
Mailing Address - Fax:740-494-4087
Practice Address - Street 1:171 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:OH
Practice Address - Zip Code:43342
Practice Address - Country:US
Practice Address - Phone:740-494-2663
Practice Address - Fax:740-494-4087
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03216543183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist