Provider Demographics
NPI:1811141179
Name:FLYNN, TIMOTHY RYAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:RYAN
Last Name:FLYNN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4082 N BRYCE CANYON AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-4958
Mailing Address - Country:US
Mailing Address - Phone:410-241-0273
Mailing Address - Fax:
Practice Address - Street 1:1650 W STATE ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4040
Practice Address - Country:US
Practice Address - Phone:208-344-8660
Practice Address - Fax:208-344-1784
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5907183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist