Provider Demographics
NPI:1225581507
Name:TIMELESS RX LLC
Entity Type:Organization
Organization Name:TIMELESS RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:REBA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEYMOUTH
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:985-893-6073
Mailing Address - Street 1:1970 N HIGHWAY 190
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-5158
Mailing Address - Country:US
Mailing Address - Phone:985-893-6073
Mailing Address - Fax:985-893-6174
Practice Address - Street 1:1970 N HIGHWAY 190
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-5158
Practice Address - Country:US
Practice Address - Phone:985-893-6073
Practice Address - Fax:985-893-6174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04133363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty