Provider Demographics
NPI:1437427945
Name:SCHICK, TIMOTHY WADE (RPH)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:WADE
Last Name:SCHICK
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 1:181 PADDON PL
Mailing Address - Street 2:UNIT 103
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-2910
Mailing Address - Country:US
Mailing Address - Phone:831-920-2627
Mailing Address - Fax:
Practice Address - Street 1:1055 FREMONT BLVD
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:CA
Practice Address - Zip Code:93955-5712
Practice Address - Country:US
Practice Address - Phone:831-393-9231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66277183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist