Provider Demographics
NPI:1922138577
Name:WAYMIRE, TIMOTHY OWEN (RPH)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:OWEN
Last Name:WAYMIRE
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 1:2016 NE 1ST
Mailing Address - Street 2:BOX 97
Mailing Address - City:ELK HORN
Mailing Address - State:IA
Mailing Address - Zip Code:51531-0097
Mailing Address - Country:US
Mailing Address - Phone:712-764-2334
Mailing Address - Fax:712-764-2337
Practice Address - Street 1:4022 MAIN ST
Practice Address - Street 2:
Practice Address - City:ELK HORN
Practice Address - State:IA
Practice Address - Zip Code:51531-0355
Practice Address - Country:US
Practice Address - Phone:712-764-2334
Practice Address - Fax:712-764-2337
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17110183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist