Provider Demographics
NPI:1013515998
Name:ROCKEY, TIMOTHY
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:ROCKEY
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:TIMOTHY
Other - Middle Name:
Other - Last Name:ROCKEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:955 FRONTENAC DR
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-6522
Mailing Address - Country:US
Mailing Address - Phone:507-452-0615
Mailing Address - Fax:
Practice Address - Street 1:955 FRONTENAC DR
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-6522
Practice Address - Country:US
Practice Address - Phone:507-452-0615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120623183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist