Provider Demographics
NPI:1942626858
Name:DORN, TIMOTHY
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:DORN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 BRANNON RD
Mailing Address - Street 2:
Mailing Address - City:HORSE SHOE
Mailing Address - State:NC
Mailing Address - Zip Code:28742-4766
Mailing Address - Country:US
Mailing Address - Phone:954-990-9807
Mailing Address - Fax:
Practice Address - Street 1:140 WEAVER BLVD
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-8345
Practice Address - Country:US
Practice Address - Phone:828-645-7499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-16
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23096183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist