Provider Demographics
NPI:1255521720
Name:GRAINGER-ROUSSEAU, TIMOTHY-JOHN (BPHARM, PHD, RPH)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY-JOHN
Middle Name:
Last Name:GRAINGER-ROUSSEAU
Suffix:
Gender:M
Credentials:BPHARM, PHD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7430 SW ARCHER RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-4610
Mailing Address - Country:US
Mailing Address - Phone:352-347-2047
Mailing Address - Fax:
Practice Address - Street 1:7430 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-4610
Practice Address - Country:US
Practice Address - Phone:352-374-2047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32613183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPU8325OtherCONSULTANT PHARMACIST
FLPS32613OtherPHARMACIST