Provider Demographics
NPI:1174964043
Name:HARTSHORN, TIMOTHY THOMAS
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:THOMAS
Last Name:HARTSHORN
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 1:7 WILLOW LN
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NH
Mailing Address - Zip Code:03031-2204
Mailing Address - Country:US
Mailing Address - Phone:603-321-6975
Mailing Address - Fax:
Practice Address - Street 1:571 NASHUA ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NH
Practice Address - Zip Code:03055-4924
Practice Address - Country:US
Practice Address - Phone:603-673-4341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH234581183500000X
NH3897183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist