Provider Demographics
NPI:1699914523
Name:DODSON, TIMOTHY JOHN (RPH)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:JOHN
Last Name:DODSON
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 1:21633 CUSTER TRL
Mailing Address - Street 2:
Mailing Address - City:NEMO
Mailing Address - State:SD
Mailing Address - Zip Code:57759-7609
Mailing Address - Country:US
Mailing Address - Phone:605-578-3831
Mailing Address - Fax:
Practice Address - Street 1:21633 CUSTER TRL
Practice Address - Street 2:
Practice Address - City:NEMO
Practice Address - State:SD
Practice Address - Zip Code:57759-7609
Practice Address - Country:US
Practice Address - Phone:605-578-3831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR38241835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist