Provider Demographics
NPI:1922013341
Name:TIMINEY, TANYA RENEE (RPH)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:RENEE
Last Name:TIMINEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 SCOTTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-2961
Mailing Address - Country:US
Mailing Address - Phone:734-384-9947
Mailing Address - Fax:
Practice Address - Street 1:15521 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-3954
Practice Address - Country:US
Practice Address - Phone:734-243-5656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302030282183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist