Provider Demographics
NPI:1154739233
Name:TOOLEY, TIMOTHY (PHAMDRP)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:
Last Name:TOOLEY
Suffix:
Gender:M
Credentials:PHAMDRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 426
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:NE
Mailing Address - Zip Code:68651-0426
Mailing Address - Country:US
Mailing Address - Phone:402-747-8994
Mailing Address - Fax:402-747-8909
Practice Address - Street 1:415 HAWKEYE STREET
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:NE
Practice Address - Zip Code:68651
Practice Address - Country:US
Practice Address - Phone:402-747-8994
Practice Address - Fax:402-747-8909
Is Sole Proprietor?:No
Enumeration Date:2014-08-01
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9541183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist