Provider Demographics
NPI:1881764819
Name:SMITH, TIMOTHY JOSEPH (PD, NFA, FASCP)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JOSEPH
Last Name:SMITH
Suffix:
Gender:M
Credentials:PD, NFA, FASCP
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 15668
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70175-5668
Mailing Address - Country:US
Mailing Address - Phone:504-812-9690
Mailing Address - Fax:504-561-0001
Practice Address - Street 1:1221 SAINT ANDREW ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130-5121
Practice Address - Country:US
Practice Address - Phone:504-812-9690
Practice Address - Fax:504-561-0001
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13938183500000X
TX33192183500000X
CO13255183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist