Provider Demographics
NPI:1396045209
Name:MCGINNIS, TIMOTHY T
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:T
Last Name:MCGINNIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:TIM
Other - Middle Name:
Other - Last Name:MCGINNIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:PO BOX 358
Mailing Address - Street 2:700 HWY 101
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439-0012
Mailing Address - Country:US
Mailing Address - Phone:541-902-1905
Mailing Address - Fax:541-902-1908
Practice Address - Street 1:700 HWY 101
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439-7626
Practice Address - Country:US
Practice Address - Phone:541-902-1905
Practice Address - Fax:541-902-1908
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0007538183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist