Provider Demographics
NPI:1205911633
Name:PEARSON, TIMOTHY JULIAN (PD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JULIAN
Last Name:PEARSON
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 E OAK ST
Mailing Address - Street 2:
Mailing Address - City:SISSETON
Mailing Address - State:SD
Mailing Address - Zip Code:57262-1630
Mailing Address - Country:US
Mailing Address - Phone:605-698-3567
Mailing Address - Fax:
Practice Address - Street 1:420 VETERANS AVE
Practice Address - Street 2:
Practice Address - City:SISSETON
Practice Address - State:SD
Practice Address - Zip Code:57262-1402
Practice Address - Country:US
Practice Address - Phone:605-698-3622
Practice Address - Fax:605-698-3622
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3598183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist