Provider Demographics
NPI:1437428471
Name:MCCREADY, TIM E (RPH)
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:E
Last Name:MCCREADY
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 1:9770 W 115TH TER
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2927
Mailing Address - Country:US
Mailing Address - Phone:913-469-6575
Mailing Address - Fax:
Practice Address - Street 1:9770 W 115TH TER
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2927
Practice Address - Country:US
Practice Address - Phone:913-469-6575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO42305183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist