Provider Demographics
NPI:1366970972
Name:O'SHEA, TIMOTHY (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:O'SHEA
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2084 STATE ROUTE 208
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549-2611
Mailing Address - Country:US
Mailing Address - Phone:845-769-9203
Mailing Address - Fax:
Practice Address - Street 1:2084 STATE ROUTE 208
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:NY
Practice Address - Zip Code:12549-2611
Practice Address - Country:US
Practice Address - Phone:845-769-9203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI062775-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist