Provider Demographics
NPI:1467936989
Name:SMITH, TIMOTHY RAYMOND (RPH)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:RAYMOND
Last Name:SMITH
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 1:19500 NORMANDIE AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-1108
Mailing Address - Country:US
Mailing Address - Phone:310-803-4036
Mailing Address - Fax:310-747-3979
Practice Address - Street 1:19500 NORMANDIE AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-1108
Practice Address - Country:US
Practice Address - Phone:310-803-4036
Practice Address - Fax:303-322-7022
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist