Provider Demographics
NPI:1952404063
Name:REAGAN, TIM WAYNE (PHARMD)
Entity type:Individual
Prefix:
First Name:TIM
Middle Name:WAYNE
Last Name:REAGAN
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 1:563 EVERVILLE DR
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:38570-6058
Mailing Address - Country:US
Mailing Address - Phone:931-510-7375
Mailing Address - Fax:
Practice Address - Street 1:8456 HIGHWAY 111
Practice Address - Street 2:
Practice Address - City:BYRDSTOWN
Practice Address - State:TN
Practice Address - Zip Code:38549-6001
Practice Address - Country:US
Practice Address - Phone:931-864-3136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21917183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist