Provider Demographics
NPI:1497277859
Name:BURNSIDE, TIMOTHY PHILLIP TALON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:PHILLIP TALON
Last Name:BURNSIDE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5618 B ST APT 4
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-3369
Mailing Address - Country:US
Mailing Address - Phone:479-221-2476
Mailing Address - Fax:
Practice Address - Street 1:1120 E GERMAN LN
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4555
Practice Address - Country:US
Practice Address - Phone:501-329-3733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD14051183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPD14051OtherPHARMACIST LICENSE