Provider Demographics
NPI:1972986099
Name:MISENHEIMER, TIMOTHY ADAM (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ADAM
Last Name:MISENHEIMER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1538 CANTERBURY TRL
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27205-8891
Mailing Address - Country:US
Mailing Address - Phone:336-953-4160
Mailing Address - Fax:
Practice Address - Street 1:207 N FAYETTEVILLE ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5529
Practice Address - Country:US
Practice Address - Phone:336-633-7611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25267183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist