Provider Demographics
NPI:1477563955
Name:BECKER, TIMOTHY DALE (RPH)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:DALE
Last Name:BECKER
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 1:1010 4TH ST SW
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-2857
Mailing Address - Country:US
Mailing Address - Phone:641-422-6109
Mailing Address - Fax:641-422-6107
Practice Address - Street 1:1010 4TH ST SW
Practice Address - Street 2:SUITE 110
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-2857
Practice Address - Country:US
Practice Address - Phone:641-422-6109
Practice Address - Fax:641-422-6107
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA15455183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist