Provider Demographics
NPI:1922697614
Name:KAISER, TIM R (RPH)
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:R
Last Name:KAISER
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 1:227 BERKSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:RINEYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40162-9677
Mailing Address - Country:US
Mailing Address - Phone:270-735-2133
Mailing Address - Fax:
Practice Address - Street 1:134 HEARTLAND DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2778
Practice Address - Country:US
Practice Address - Phone:270-769-3100
Practice Address - Fax:270-769-0890
Is Sole Proprietor?:No
Enumeration Date:2021-01-16
Last Update Date:2021-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011076183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist