Provider Demographics
NPI:1245212083
Name:REDLINE, TIMOTHY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:REDLINE
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 1:401 W 33RD ST
Mailing Address - Street 2:#100
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-2577
Mailing Address - Country:US
Mailing Address - Phone:402-462-2929
Mailing Address - Fax:402-462-2932
Practice Address - Street 1:401 W 33RD ST
Practice Address - Street 2:#100
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-2577
Practice Address - Country:US
Practice Address - Phone:402-462-2929
Practice Address - Fax:402-462-2932
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11214183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist