Provider Demographics
NPI:1538271010
Name:SMITH, TIMOTHY B (RPH)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:B
Last Name:SMITH
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 1:180 EAST 300 NORTH
Mailing Address - Street 2:PO BOX 204
Mailing Address - City:PANGUITCH
Mailing Address - State:UT
Mailing Address - Zip Code:84759-0204
Mailing Address - Country:US
Mailing Address - Phone:435-676-8747
Mailing Address - Fax:435-676-2679
Practice Address - Street 1:200 NORTH 400 EAST
Practice Address - Street 2:
Practice Address - City:PANGUITCH
Practice Address - State:UT
Practice Address - Zip Code:84759-0389
Practice Address - Country:US
Practice Address - Phone:435-676-1277
Practice Address - Fax:435-676-2679
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT153942-1719183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist