Provider Demographics
NPI:1972014298
Name:HEATH, TIMOTHY
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:HEATH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:16666-0157
Mailing Address - Country:US
Mailing Address - Phone:814-577-4653
Mailing Address - Fax:
Practice Address - Street 1:3106 E PLEASANT VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-8935
Practice Address - Country:US
Practice Address - Phone:814-742-8429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-13
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP451826183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist