Provider Demographics
NPI:1992244024
Name:MEAD, TIMOTHY IRA (RPH)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:IRA
Last Name:MEAD
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 1:813 PIKES PEAK CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-3110
Mailing Address - Country:US
Mailing Address - Phone:303-460-9474
Mailing Address - Fax:303-460-0850
Practice Address - Street 1:813 PIKES PEAK CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-3110
Practice Address - Country:US
Practice Address - Phone:303-665-3645
Practice Address - Fax:303-460-0850
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10319183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist