Provider Demographics
NPI:1306351598
Name:ANDRES, TIMOTHY CHARLES (RPH)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:CHARLES
Last Name:ANDRES
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 1:1022 CEMENT AVE
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-1707
Mailing Address - Country:US
Mailing Address - Phone:567-238-5180
Mailing Address - Fax:419-239-2628
Practice Address - Street 1:226 E PERKINS AVE
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-4905
Practice Address - Country:US
Practice Address - Phone:419-239-2624
Practice Address - Fax:419-239-2628
Is Sole Proprietor?:No
Enumeration Date:2017-12-09
Last Update Date:2017-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03315876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist