Provider Demographics
NPI:1174817282
Name:OGUREK, TIMOTHY ANDREW
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:ANDREW
Last Name:OGUREK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 S LOOP 288
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-4801
Mailing Address - Country:US
Mailing Address - Phone:940-220-2123
Mailing Address - Fax:940-220-2123
Practice Address - Street 1:1801 S LOOP 288
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-4801
Practice Address - Country:US
Practice Address - Phone:940-220-2123
Practice Address - Fax:940-220-2123
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23246183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist