Provider Demographics
NPI:1013798784
Name:JETTON, TIMOTHY GLENN (RPH)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:GLENN
Last Name:JETTON
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 1:10001 NEW HAMPSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-1707
Mailing Address - Country:US
Mailing Address - Phone:240-402-8666
Mailing Address - Fax:
Practice Address - Street 1:10001 NEW HAMPSHIRE AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-1707
Practice Address - Country:US
Practice Address - Phone:240-402-8666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD131501835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care