Provider Demographics
NPI:1194499640
Name:TIMBILLA, RAHINATU
Entity type:Individual
Prefix:
First Name:RAHINATU
Middle Name:
Last Name:TIMBILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 BENJI CIR
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541-4806
Mailing Address - Country:US
Mailing Address - Phone:631-889-9251
Mailing Address - Fax:
Practice Address - Street 1:2609 BENJI CIR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78541-4806
Practice Address - Country:US
Practice Address - Phone:631-889-9251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68803183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist