Provider Demographics
NPI:1326208836
Name:DENIS, TIMOTHY J (RPH)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:DENIS
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 1:88 RAMBLESIDE DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-2028
Mailing Address - Country:US
Mailing Address - Phone:419-565-0857
Mailing Address - Fax:
Practice Address - Street 1:2205 WALKER LAKE RD
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OH
Practice Address - Zip Code:44903-6519
Practice Address - Country:US
Practice Address - Phone:419-747-1450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-23553183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist