Provider Demographics
NPI:1578780755
Name:SISK, TIMOTHY Q (RPH)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:Q
Last Name:SISK
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 1:336 RAES CREEK DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-1989
Mailing Address - Country:US
Mailing Address - Phone:864-268-0130
Mailing Address - Fax:
Practice Address - Street 1:1402 HIGHWAY 101 S
Practice Address - Street 2:AREA B
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-6731
Practice Address - Country:US
Practice Address - Phone:866-817-0411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6537183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist