Provider Demographics
NPI:1396758736
Name:TIMMONS, RICK R (RPH)
Entity type:Individual
Prefix:MR
First Name:RICK
Middle Name:R
Last Name:TIMMONS
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 1:3001 SCHNEIDMAN RD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-3541
Mailing Address - Country:US
Mailing Address - Phone:270-443-7200
Mailing Address - Fax:270-443-8537
Practice Address - Street 1:3001 SCHNEIDMAN RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3541
Practice Address - Country:US
Practice Address - Phone:270-443-7200
Practice Address - Fax:270-443-8537
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9042183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9042OtherSTATE LICENSE#