Provider Demographics
NPI:1386704534
Name:NORMAN, TIMOTHY HOWARD (RPH)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:HOWARD
Last Name:NORMAN
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 1:1184 SWEETWATER CIR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-3142
Mailing Address - Country:US
Mailing Address - Phone:770-313-1097
Mailing Address - Fax:770-564-8741
Practice Address - Street 1:1184 SWEETWATER CIR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-3142
Practice Address - Country:US
Practice Address - Phone:770-313-1097
Practice Address - Fax:770-564-8741
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA013221183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA013221OtherSTATE LIC