Provider Demographics
NPI:1265032809
Name:THORNTON, TIMOTHY WAYNE (RPH)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:WAYNE
Last Name:THORNTON
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 1:19091 I 45 S
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77385-8748
Mailing Address - Country:US
Mailing Address - Phone:936-271-1760
Mailing Address - Fax:936-271-1776
Practice Address - Street 1:19091 I 45 S
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77385-8748
Practice Address - Country:US
Practice Address - Phone:936-271-1760
Practice Address - Fax:936-271-1776
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30560183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist