Provider Demographics
NPI:1215324629
Name:STARRY, TIMOTHY PATRICK (RPH)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:PATRICK
Last Name:STARRY
Suffix:
Gender:M
Credentials:RPH
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 129
Mailing Address - Street 2:
Mailing Address - City:OCONTO FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54154-0129
Mailing Address - Country:US
Mailing Address - Phone:920-848-3721
Mailing Address - Fax:920-848-4374
Practice Address - Street 1:323 E HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:OCONTO FALLS
Practice Address - State:WI
Practice Address - Zip Code:54154-1006
Practice Address - Country:US
Practice Address - Phone:920-848-3721
Practice Address - Fax:920-848-4374
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13335183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist