Provider Demographics
NPI:1881962496
Name:COLYER, TIM WAYNE (RPH)
Entity type:Individual
Prefix:MR
First Name:TIM
Middle Name:WAYNE
Last Name:COLYER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
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Mailing Address - Street 1:4881 COX RD
Mailing Address - Street 2:BUILDING #1
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-6293
Mailing Address - Country:US
Mailing Address - Phone:804-270-3784
Mailing Address - Fax:804-270-9149
Practice Address - Street 1:4881 COX RD
Practice Address - Street 2:BUILDING #1
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-6293
Practice Address - Country:US
Practice Address - Phone:804-270-3784
Practice Address - Fax:804-270-9149
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0202009375183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist