Provider Demographics
NPI:1821362872
Name:KITCHENS, TIMOTHY S (RPH)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:S
Last Name:KITCHENS
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 1:831 S CAROLINA RD
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:AL
Mailing Address - Zip Code:35592-3839
Mailing Address - Country:US
Mailing Address - Phone:910-620-4747
Mailing Address - Fax:
Practice Address - Street 1:2601 CASTLE HAYNE RD STE B
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-2690
Practice Address - Country:US
Practice Address - Phone:910-763-6231
Practice Address - Fax:910-763-2983
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11904183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0655992Medicaid