Provider Demographics
NPI:1528347010
Name:MCCARTY, TIMOTHY PATRICK (PHARMD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:PATRICK
Last Name:MCCARTY
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 1:340 COLLEY SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:CLINTWOOD
Mailing Address - State:VA
Mailing Address - Zip Code:24228-5756
Mailing Address - Country:US
Mailing Address - Phone:276-926-6890
Mailing Address - Fax:276-926-6893
Practice Address - Street 1:340 COLLEY SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:CLINTWOOD
Practice Address - State:VA
Practice Address - Zip Code:24228-5756
Practice Address - Country:US
Practice Address - Phone:276-926-6890
Practice Address - Fax:276-926-6893
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA020204666183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist