Provider Demographics
NPI:1215334792
Name:CARROLL, TIMOTHY JOEL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JOEL
Last Name:CARROLL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 EARHART DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7809
Mailing Address - Country:US
Mailing Address - Phone:716-532-7362
Mailing Address - Fax:716-532-7360
Practice Address - Street 1:45 EARHART DR
Practice Address - Street 2:SUITE 110
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14221-7809
Practice Address - Country:US
Practice Address - Phone:716-532-7362
Practice Address - Fax:716-532-7360
Is Sole Proprietor?:No
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058295183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist