Provider Demographics
NPI:1518429505
Name:WORSHAM, TIM LYN (RPH)
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:LYN
Last Name:WORSHAM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:TIM
Other - Middle Name:
Other - Last Name:WORSHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:1466 COUNTY ROAD 3405
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75766-6341
Mailing Address - Country:US
Mailing Address - Phone:903-284-8325
Mailing Address - Fax:
Practice Address - Street 1:1466 COUNTY ROAD 3405
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-6341
Practice Address - Country:US
Practice Address - Phone:903-284-8325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30348183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist