Provider Demographics
NPI:1083131718
Name:WILLMORE, TIMOTHY RONALD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:RONALD
Last Name:WILLMORE
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 1:3124 RACINE ST APT 209
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-6671
Mailing Address - Country:US
Mailing Address - Phone:816-456-9820
Mailing Address - Fax:
Practice Address - Street 1:3227 NORTHWEST AVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1317
Practice Address - Country:US
Practice Address - Phone:360-647-2175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60772319183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist