Provider Demographics
NPI:1699077073
Name:NAGAKI, TIM T (RPH)
Entity type:Individual
Prefix:MR
First Name:TIM
Middle Name:T
Last Name:NAGAKI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:601 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-3517
Mailing Address - Country:US
Mailing Address - Phone:308-635-1444
Mailing Address - Fax:308-635-2746
Practice Address - Street 1:601 BROADWAY
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-3517
Practice Address - Country:US
Practice Address - Phone:308-635-1444
Practice Address - Fax:308-635-2746
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8714183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist