Provider Demographics
NPI:1992829519
Name:NWAKO, TIMOTHY II (PHARMACIST)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:NWAKO
Suffix:II
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5017 ZEBULON RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-2131
Mailing Address - Country:US
Mailing Address - Phone:478-390-2658
Mailing Address - Fax:
Practice Address - Street 1:5017 ZEBULON RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-2131
Practice Address - Country:US
Practice Address - Phone:478-390-2658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0197301835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy