Provider Demographics
NPI:1427433010
Name:TYMOCHKO, NICHOLAS STANLEY (PHARMD)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:STANLEY
Last Name:TYMOCHKO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 E ROOSEVELT ST
Mailing Address - Street 2:APT 520
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1934
Mailing Address - Country:US
Mailing Address - Phone:724-456-1399
Mailing Address - Fax:
Practice Address - Street 1:10705 W INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-5636
Practice Address - Country:US
Practice Address - Phone:623-877-3245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS020662183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist