Provider Demographics
NPI:1598019762
Name:TIMI PHARMACY SERVICES
Entity Type:Organization
Organization Name:TIMI PHARMACY SERVICES
Other - Org Name:LIVING WELL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IDAYAT
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEWUNMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-574-4754
Mailing Address - Street 1:723 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-1166
Mailing Address - Country:US
Mailing Address - Phone:347-574-4754
Mailing Address - Fax:
Practice Address - Street 1:723 N BROAD ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-1166
Practice Address - Country:US
Practice Address - Phone:302-378-8228
Practice Address - Fax:302-378-7338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-08
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE6882720001Medicare NSC