Provider Demographics
NPI:1740886985
Name:GRIFFIN, TIMOTHY LEE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:LEE
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:TIMOTHY
Other - Middle Name:L
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:138 COURTLAND DR
Mailing Address - Street 2:
Mailing Address - City:SALTILLO
Mailing Address - State:MS
Mailing Address - Zip Code:38866-6007
Mailing Address - Country:US
Mailing Address - Phone:662-279-0599
Mailing Address - Fax:662-423-9318
Practice Address - Street 1:1411 W QUITMAN ST
Practice Address - Street 2:
Practice Address - City:IUKA
Practice Address - State:MS
Practice Address - Zip Code:38852-1130
Practice Address - Country:US
Practice Address - Phone:662-423-9039
Practice Address - Fax:662-423-9318
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE194871835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSE14987OtherSTATE BOARD OF PHARMACY