Provider Demographics
NPI:1689906919
Name:CHIN, TIM K (R PH)
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:K
Last Name:CHIN
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 THERESA AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-4000
Mailing Address - Country:US
Mailing Address - Phone:781-273-4713
Mailing Address - Fax:
Practice Address - Street 1:140 WHALON ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-7158
Practice Address - Country:US
Practice Address - Phone:508-345-7540
Practice Address - Fax:508-348-2179
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-11
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17403183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist