Provider Demographics
NPI:1699168138
Name:LYNCH, TIM HAROLD (RPH)
Entity type:Individual
Prefix:MR
First Name:TIM
Middle Name:HAROLD
Last Name:LYNCH
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 1:4200 BAIR AVE
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34731-5616
Mailing Address - Country:US
Mailing Address - Phone:352-787-4701
Mailing Address - Fax:
Practice Address - Street 1:4200 BAIR AVE
Practice Address - Street 2:
Practice Address - City:FRUITLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:34731-5616
Practice Address - Country:US
Practice Address - Phone:352-787-4701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS14277183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist