Provider Demographics
NPI:1588913578
Name:BUCHANAN, TIMMELLYN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TIMMELLYN
Middle Name:
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 S SANTA ROSA ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-3433
Mailing Address - Country:US
Mailing Address - Phone:469-525-7776
Mailing Address - Fax:
Practice Address - Street 1:800 NEW LOS ANGELES AVE
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-3585
Practice Address - Country:US
Practice Address - Phone:469-525-7776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67483183500000X
OK15003183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist