Provider Demographics
NPI:1760475016
Name:TIM'S PHARMACY & GIFT SHOP, LTD
Entity Type:Organization
Organization Name:TIM'S PHARMACY & GIFT SHOP, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:360-458-8467
Mailing Address - Street 1:PO BOX 5120
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-5120
Mailing Address - Country:US
Mailing Address - Phone:360-458-8467
Mailing Address - Fax:360-206-5157
Practice Address - Street 1:106 1ST ST S
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-7700
Practice Address - Country:US
Practice Address - Phone:360-458-8467
Practice Address - Fax:360-206-5157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF00002080183500000X
3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4910522OtherNCPDP
WA6103204Medicaid
WA0582620002Medicare NSC