Provider Demographics
NPI:1932709391
Name:TIERNEY, ROBERT DANIEL
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DANIEL
Last Name:TIERNEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140-9326
Mailing Address - Country:US
Mailing Address - Phone:740-852-2726
Mailing Address - Fax:740-852-2984
Practice Address - Street 1:375 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-9326
Practice Address - Country:US
Practice Address - Phone:740-852-2726
Practice Address - Fax:740-852-2984
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03225243183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist