Provider Demographics
NPI:1497400394
Name:GARDNER, TIMOTHY MARTIN (RPH)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:MARTIN
Last Name:GARDNER
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 1:255 TOWN LOOP
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65706-7549
Mailing Address - Country:US
Mailing Address - Phone:417-844-8129
Mailing Address - Fax:
Practice Address - Street 1:490 MEDICAL DRIVE
Practice Address - Street 2:
Practice Address - City:ASH GROVE
Practice Address - State:MO
Practice Address - Zip Code:65604
Practice Address - Country:US
Practice Address - Phone:417-751-2111
Practice Address - Fax:417-751-3112
Is Sole Proprietor?:No
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO044037183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist