Provider Demographics
NPI:1205012283
Name:O'NEIL, TIMOTHY MARK (RPH)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:MARK
Last Name:O'NEIL
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 1:2405 VESTAL PKWY
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-2018
Mailing Address - Country:US
Mailing Address - Phone:607-798-1544
Mailing Address - Fax:607-770-7304
Practice Address - Street 1:2405 VESTAL PKWY
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2018
Practice Address - Country:US
Practice Address - Phone:607-798-1544
Practice Address - Fax:607-770-7304
Is Sole Proprietor?:No
Enumeration Date:2008-01-21
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037804183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist