Provider Demographics
NPI:1831192442
Name:BANISTER, TIMOTHY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:BANISTER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 HOSPITAL PKWY
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6920
Mailing Address - Country:US
Mailing Address - Phone:817-359-9070
Mailing Address - Fax:817-359-9025
Practice Address - Street 1:1609 HOSPITAL PKWY
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6920
Practice Address - Country:US
Practice Address - Phone:817-359-9070
Practice Address - Fax:817-359-9025
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX337421835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology